Transactions of the North Carolina Dental Society Annual Meeting

NORTH CAROLINA HISTORY OF HEALTH DIGITAL COLLECTION  

Volume 30 (1904)

DOCUMENT NO. NCHH-32-030   

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OF THE

North Carolina Dental Society

AT THE

THIRTIETH ANNUAL SESSION

HELD AT

MOREHEAD CITY, N. C.

Commencing June 29th, 1904

PUBLISHING COMMITTEE, F. L. HUNT

asheville, n. c. The Hackney & Moale Company 1904 CONTENTS. PAGE President's Address — Martin Fleming J. 3 The Jewel of Good Deed— P. E. Horton n

Prophylaxis—R. T. Allen I4 After Porcelain — What ? — J. C. Watkins 19 Something " on" Porcelain —J. A. Gorman 37 Porcelain Inlay D. — J. Whitaker 39 Abutments and Bands A. — H. Fleming 45 Rubber Plates — L. L. Dameron 49 Dental Education — W. M. Robey 53 Some Forms of Crystal Gold, Their Range and Limitations — F. S. Harris 5!

Cohesive Gold and Amalgam — C. A. Bland 69 Ethics and Jurisprudence — E. J. Tucker 74 Dentistry From a Business Standpoint — W. B. Ramsay.. 78 Occlusion and Retention of the Permanent Teeth Consid-

ered in Relation to Orthodontia — J. N. Johnson 81

Clean Flands in Dentistry — J. H. Brooks 87

Some Practical Points Learned by Nearly Thirty Years of Actual Practice — I. N. Carr 92

Some of the Uses of Gutta Percha — I. W. Jamieson 102

Report of Clinics — H. D. Harper, Sr 107

Life and Character of Dr. J. A. Ballentine — R. E. Ware. . . 107 :

PROCEEDINGS

The Thirtieth Annual Session of the North Carolina Den- tal Association was called to order at Morehead City, on Wednesday evening, June 29, 1904, at 9 o'clock, President Dr.

J. Martin Fleming in the chair. Prayer was offered by the Rev. R. H. Willis, pastor of the Methodist Episcopal Church, South, of Morehead City. The roll of members was then called. On motion of Dr. D. E. Everitt, the reading of the Min- 4 utes of the previous session was dispensed with. J Dr. J. A. Gorman, First Vice-President of the Society, took the: chachair and President Fleming read his annual address as follows

PRESIDENT'S ADDRESS.

Mr. President, Ladies and Gentlemen:

Time in its ceaseless roll has brought us again to the completion of another year in the life of the North Carolina Dental Society. A year filled with honors and with work — elements which tend to make for us a success. The year has witnessed a steady growth in all that is best in the profession. We begin the work of the Thirtieth Annual Meeting with feelings of pride in our past and with pleasant anticipation of the future. The North Carolina Society has reason to be proud of the record of its year's work. The National Convention has met within our borders, bringing with it and diffusing among us all that is best and newest in dentistry, and carrying away with them a knowledge that the members of the profession in North Carolina are standing in the very forefront of dentistry, " workmen, needing not to be ashamed." Members of this Society have been and are being sought as Clin- icians, and the clinics given by them have been an honor to their State Society and to the profession which they represent. These facts are not mentioned in any boastful spirit, but rather to encourage us to put forth our best endeavors in this thirtieth year of the life of the Society. There is naturally a craving in our natures for the attainment of something nobler and higher, and if we come to this, our annual meeting, to stimulate this desire and craving, by a free interchange of ideas and a full appreciation of the advantages that such meetings afford, each one, from the most learned to the most ignorant, will carry home something that will be of advantage to him and to the public whom we serve. 4 PROCEEDINGS OF NORTH CAROLINA

MEMBERSHIP.

A more systematic effort has been made this year than for several years past to increase the membership of the Society by the addition of the names of ethical men from all parts of the State. It is a well known fact that only about one-third of the dentists in the State belong to the Society. This condition is partly the fault of the dentists themselves and partly the fault of the members of the Society. A little exertion on the part of each member would almost double our membership in one year. The Medical Society has done some good work along this line within the last year, and while their plan is not suited to us, we might certainly learn a lesson from their exertions. They began by appointing a district organizer for each district, and he in turn was to see to it that each county was organized and membership in a county organization entitled one to membership in the State organization. There are not enough of us, probably, to carry out this plan successfully — and yet there are many counties where a county organization could be carried on effectually, and this should be done. . Local societies, both city and county, do more for the uplifting of dentistry, more for lessening the evils of low prices, more to stimulate a personal friendship among its members than any other one remedy. Quite a number of such local societies are already in existence and the benefits accruing to their members have been far-reaching. Acting under the recommendation of our former president, from whom the Society has gotten many valuable points, a committee of one from each congressional district has been appointed to look into the matter and see how many eligible men are to be found in each district, and to make some systematic effort to enroll them as members. This system should be kept up and thoroughly worked from year to year and we will soon have approached every man in the State, and if the matter is presented in the right way, many will be induced to join. It is a fact that is becoming more and more noticeable that patients will ask if such and such a man is a member of the State Society. They recognize the fact that a man cannot keep abreast of the times who does not attend the meetings, and they do not care to patronize a man who is not a member. Persons who are not members will often say to such patients that they know they should be members and that they will join at the next meeting. Of course this does not apply to all non-members. Some have so conducted themselves as to be forever beyond the pale of professional decency — but such little statements from patients show only too clearly that it means something in North Carolina to be a member of the Society and that the sentiment is growing in the State that the members of the Society have every advantage over those who are not members. I take no pessimistic view of the dangers that threaten us along the line of quackery. There are too many people who want only the best — those who wish only the cheapest are not the class that DENTAL SOCIETY 5 a first-class patronage is built from, and those doing this work are never those who build the best practice, and they are as cognizant of the fact as we. Some feel that necessity has driven them to advertising — often the very fact of advertising is a virtual acknowledgment of failure, and those who do it look forward to the day when they can throw off the shackels of non-professional life and take their place among men again. They are bound to feel the ostracism and we should not be too backward in lending them a helping hand and letting them feel that they can redeem a place among professional gentlemen. FINANCES.

The finances of the Society are in a somewhat depleted condition owing to unusual expenses incurred during the last few years. In order to meet our expenses during the past year the Society has had to borrow $150, giving the individual notes of the president, secetary and treasurer for the amount. The unusual expense which has caused this deficit has been chiefly for work and expenses of the Text Book Committee, and the increased amount of work done at our annual meetings has caused us to spend more than treble the amount formerly spent in printing. It has been money well spent, our transactions are a great credit to our Society and are eagerly sought after, especially the editions so ably edited and nicely printed for the past two years, but I would recommend with the present condition of our treasury that they be carefully condensed, not omitting a single good point, but editing it with a view to lessening the expenses of publishing while preserving the quality of the publication. It is not an easy task and it is only mentioned because the writer of this paper knows of the arduous toil of the chairman of the publishing committee and his sympathies are all with him. It is the most laborious work of any connected with our organization. As a great help to the treasurer in meeting the expenses we need only to suggest that we pay our dues promptly, not allowing ourselves to become and to stay a year behind but to be paid up to date. It would be well to enforce our constitution along this line, allowing no one in arrears the privilege of the floor, nor the privilege of casting a ballot. EDUCATION. The subject of Dental Education has come up from year to year and been discussed till some of us may think it has become thread- pro- bare — but it is a subject underlying the very foundtion of our fession and should be carefully studied each succeeding year. Few will treat it in the same way and some new thought may be added to the subject. So far the discussion has turned towards the Dental Education and requirements for entrance to Dental Colleges. In standpoint. the present case I desire to treat it from a different of an It is hardly fair to a man who has not had advantages education to say that an educated man can, in all cases or even in most cases, do better work — such is not the case. A skilled workman performs skilled work educated or uneducated. But the standing of a 6 PROCEEDINGS OF NORTH CAROLINA dentist in his community is certainly dependent upon his ability to hold his place among the best people, and those are always the educated. A community expects it of its lawyers, teachers,, physicians and other professional men, and it has a right to expect it of its dentists. Every dentist should therefore be a leader in the best thought and action of his community and thus raise the standard of educational requirements. Such a course would naturally deter the unfitted from entering the profession. Some years ago a young man approached a member of this Society to ask his advice about studying dentistry — he was advised to first take a thorough college course before he began his dental course. He did this and then decided to study law instead. He never would have thought of studying law without being educated, but he thought that dentistry required less educational foundation. Such a man would never have brought honor to the profession and a friendly turn was done him when he was advised to take a college course. Similar occasions come to most of us and we will surely help our educational standard by giving similar advice. The members of the profession themselves can do more, along the lines suggested, to keep out the uneducated, than all the entrance examinations to dental colleges. The colleges are doing their part towards uplifting the standard and it only remains for the dentists to exert themselves to encourage a higher aim in all who would study dentistry. SOCIETY WORK AND PAPERS.

During an experience running through the last few years the difficulty one meets in attempting to get out an attractive programme has become painfully prominent. The committees are selected with the greatest possible care by the Executive Committee. The chairmen of the committees are written to, some reply and some do not. The chairmen in turn write to the men under them — some of these reply and some do not. And so it goes on till right up to the time that the programme should be printed and much unnecessary labor each is put upon the secretary. I have sometimes wished that member of the Society might serve one term as secretary and one as president that he might see the situation as it really is, and every one become a helper in this work. During a correspondence along this line last year, one of the very wrote that best, if not the best, writers of papers in the Society, he did not feel equal to the subject assigned him, but that he would attempt it. .... He said further that for some years he had found it beneficial to periodically select a given subject, take a course of study on it, and public. " It write out in full as though it were to be given to the teaches one to reason, to draw conclusions, and above all, to express one's self intelligently." He wrote further that his only regret was that the habit did not fix itself upon him earlier in life. If this view of the matter could be impressed upon our member- all hesitate to do it ship, it would bear phenomenal results. We that careful study because it entails some work, yet we each one know and the preparation of a paper will teach one more than he ever knew of a subject. , . as much And so this appeal is made to the membership to lend DENTAL SOCIETY 7 aid as possible to those laboring to arrange an attractive programme — the work will repay us.

SOCIETIES.

There has been a feeling throughout the South for some years that the other sections of the country — North and East — have not lived up to the agreement made at the time of the organization of the National Dental Society at Old Point in 1897. We believe that the National Dental Society should have tributaries from each sec- tion. There is a feeling that while we have performed our part of the contract the other sections have not done so, and that we have given up one of the finest dental organizations ever known, the Southern, to become a branch or feeder to the National, for five years contributing three-fifths of our dues to its support and for two years contributing two-fifths. As I said, there is a growing feeling that we have not had value received, and there are many who think that a new Society should be organized upon a basis similar to the old Southern, a Society owing allegiance to no other — a branch of no other. Looking to this end there met, in the parlors of the Riggs House, during the meeting of the Southern Branch of the National Dental Association at Washington, a few representative men of the South to look into the advisability of organizing a new Society. The resolutions as set forth at that meeting gave the chairman of the meeting authority to appoint one representative from each State and to appoint some time and place to meet and organize the new Society. The resolutions disclaim any intention of injuring any other organization but state that it shall be a new society, owing allegiance to none — a branch of none. But at the same time the membership of the new organization must necessarily come from the present membership of the other organization — and the question is whether we shall withdraw from the one and join the other, or joining the new, allow our names to be dropped from the old for non-payment of dues. We of the South should have only the one Society. Honors have come to our members from the present organization and the question of the new society is one that should be carefully weighed. If the National Organization has kept faith with the old Southern it is better to retain membership in the present organization, but if it has not kept faith we are certainly under no obligations to them. But there should be no division among us on the subject — "United we stand, divided we fall." But no matter what may come of this, not one of us should forget that we are members of the North Carolina Society and that it has first claim on our energies and that no other Society should ever supplant it in our affections.

INTERCHANGE OF LICENSE.

Probably one of the most talked of topics in dentistry today is the growing demand from dentists all over the country for a recognized interchange of license between the States — and the trend of expres- 8 PROCEEDINGS OF NORTH CAROLINA

sion is that it must sooner or later grow into a reality. Several of the Eastern States have already adopted such a system among themselves. The theory of it is probably all right and in practice it may be brought to do a great good in that it would cause, a raising of the standard for license in all States — in many of which the requirements are not now what they should be. It would necessarily do away with the custom of some States to grant licenses to holders of diplomas from Dental Colleges located within their borders, for many of the other States would certainly not accept such license in exchange for one obtained from rigid examination. Any other course would soon do away entirely with examinations. At present this has not gone further than for one or two States to agree to this interchange, but it is preparing a way for a future plan which will require an examination worthy the name, the passing of which will entitle the holder to practice where he will. The matter is mentioned that it may cause us to be thinking on the subject so that when it does finally present itself we may be prepared to meet it in the best possible manner for the good of dentistry.

DENTAL LAWS.

During the last few years there seems to have gone out in this State an idea that the Dental Laws of the State would not hold before the courts if put to the supreme test. At the last meeting of the Society, one of the applicants for license, having failed before the Board, claimed that he had been discriminated against for some reason, and concluded to test the powers of the Board before the courts and see if he could not compel them to grant him by law a license which had been refused him on a test of skill. And so the matter was carried into the courts, both the Superior and the Supreme, and in each case the decision was in favor of the Board. The results of this case will be far-reaching in that it establishes beyond question that the laws of North Carolina, pertaining to the practice of dentistry, are constitutional and that forever hereafter it settles the question as to whether or not the laws of the State shall stand. The case was stubbornly fought in the courts and not without some expense, and not only are our thanks due the members of the Examining Board, who carried the case to a successful termination, but the Society should share the expense of the suit with them. Their battles are our battles and they alone stand between us and many who, but for the thoroughness of our Board, would come into the profession unprepared and unwilling to do their full duty to the profession. The Supreme Court advised that redress could be had only in a suit for damages against the members of the Board by showing that he had been unjustly dealt with. All who know the members of the Board know they have nothing to fear from such suit, and we should let them know full well that the Society has all confidence in them both collectively and individually. DENTAL SOCIETY

SOCIETY MEETINGS.

We would call especial attention to the meeting of the Fourth International Dental Congress which meets in St. Louis, August 29th, to September 3rd. These meetings being international, it is seldom that one is held close enough for the majority of us to attend, but its coming to St. Louis this year gives us an opportunity that we should not lightly put aside. In comparison with other international meetings, it will surpass them beyond all thought and the impetus that shall be given to the profession all over this country will well repay all who come under its influence. The Congress will be made up from representatives from at least twenty nations, coming from all parts of the world and bringing together in St. Louis the very cream of dental progress for the last few years. Such an interchange of the best thought and practice is not something to be ignored, but we should exert, ourselves to take advantage of the opportunities that the meeting will afford us. Membership will be open to any man who may be a member of his State or local organization. A membership fee of $10.00 is the only certificate needed — and all who can possibly go should see Dr. C. L. Alexander, of Charlotte, who is looking after the membership from this State. Everything in connection with the meeting has been planned on the most elaborate scale and will be carried out to the minutest detail. During the year death has again invaded our ranks and taken from us a member not well known to most of us, because for the last few years he has not attended many meetings, but a more faithful practitioner or truer man has not been lost to us in a long time. It " is too true that, It is after death that we measure men." We wait too often for the magic touch of death to reveal their good qualities. But in the life of Dr. Ballentine, those who knew him knew a Christian gentleman, doing his duty to his fellowman and to his God. His place will be missed among us and it is fitting that the programme committee has set apart a memorial hour in which we may pay respect to his memory. In his death we are reminded that we might know each other better. There are some men in the Society who are comparative strangers to others, and we might exert ourselves that this condition might not longer prevail. In so doing we will soon forget the petty rivalries of life and become friends indeed. By removal to another State the Society has lost one of its very best members in the person of Dr. C. A. Rominger, of Reids- ville. As he goes to his distant home let him know full well that he takes with him the good will of every member of this Society, and that we each one wish him a hearty God-speed in his new field of labor. He will never be forgotten by the membership of this Society who will ever hold him in fond esteem. In conclusion, as we look back over the year's work with feelings of justifiable pride in the advancement of our chosen labor, and with the joy and satisfaction that come from a feeling of duty well done, :

10 PROCEEDINGS OF NORTH CAROLINA

let us be careful that we do not become too well satisfied with ourselves and our surroundings. The past is gone and we should turn with hope to the bright future, gleaning as much knowledge as possible from all sources, withholding nothing from our professional brethren, and working that each year may find us further advanced in every professional attainment. And like the chambered Nautilus,

" Build thee more stately mansions, O my soul,

As the swift seasons roll !

Leave thy low-vaulted past ! Let each new temple, nobler than the last, Shut thee from heaven with a dome more vast, Till thou at length art free, Leaving thine outgrown shell by life's unresting sea !"

On motion the address was referred to a committee con-

sisting of Drs. J. H. Benton, J. C. Watkins and J. H. Wheeler. At a subsequent meeting they reported as follows

Mr. President, and Members of the Dental Society:— Your Committee to whom was referred the President's annual address begs to report as follows: That we find it a most commendable paper, showing great consideration and care in its preparation and furnishing food for much profitable thought, and would recommend a careful perusal of the same by each and every member of the society. We desire to emphasize his remarks encouraging the formation of local societies, believing with him that local societies, both city and county, do more for the uplifting of the evils of low prices, and more to strengthen and promote friendship among their members than any other remedy. Respectfully submitted,

J. H. BENTON, Chairman; T. C. WATKINS, JNO. H. WHEELER, Committee. MINORITY REPORT.

The reference by the President, in his address relative to the organization of the Southern States Dental Society, is a subject worthy of the consideration of every dentist in North Carolina and the completion of a permanent organization of the same is to be encouraged. Respectfully submitted,

J. H. Benton, Chairman.

On motion the minority report was incorporated with the majority report and then as a whole was unanimously adopted. Dr. D. E. Everitt, Chairman of the Executive Committee, DENTAL SOCIETY 11 urged all applicants for admission to membership in the Soci- ety to hand in their applications at once in order that, if elected to membership, they might have the privilege of par- ticipating in the deliberations of the Convention. President Fleming took the chair and Dr. P. E. Horton read the Annual Essay on " The Jewel of Good Deed," as follows :

"THE JEWEL OF GOOD DEED."

Standing amid the sacred memories of the 19th century, on the golden threshold of the 20th, we know not what discoveries, or what inventions may leap from the brain of the future ; we know not what garments of glory may be woven for the world in the loom of years to be. We are just on the edge of the great ocean of discovery. " We know that Science has taken the thunder bolt from the hands of Jupiter, and now the electric spark, freighted with the thought of man flashes under waves of the sea and through the waves of the air. We know that Science has stolen a tear from the cheek of unpaid labor, converted it into steam and created a giant that turns with tireless arms the countless wheels of toil." We know that the last half century has made a name for itself that will be an inspiration to generations yet unborn. From this era of science, of rational thinking, of broader culture, of higher ideals, of better livng has sprung the science and art of dentistry. And what have been its services to humanity ? What contributions has it given to the sum total of human knowledge ? Judged from the purely humanitarian point of view, the most prominent benefit to humanity has been the relief of human suffering which its ministrations have made possible; and when we remember that anaesthesia is a product of modern dentistry, no one will question the proposition that it is a humane calling. If no other product had resulted from the work of its votaries than the discovery of this boon to humanity, that single fact would have been ample justification for its existence as a special department of the great healing art. Let those who doubt this make inquiry of the large host of sufferers who have been called upon to endure the pain of surgical operations. These know, and the spirit of their answer is poetically expressed by Prof. Truman in his Apotheosis of Anaes- thesia at the memorial banquet held in 1894 in honor of its discov- Greeks have done, erer : "We cannot defy thee as ancient would but we give thee most hearty thanks, and in our heart of hearts, we enshrine thee, O Anesthesia, goddess of our modern civilization ! — though not the first born, the loveliest of all the children of discovery in this our 19th century." But this is not all. It has demonstrated the importance of sound teeth to good health. It has, in a measure, accomplished the restoration of dental organs lost in whole or in part by disease. It has secured to those of middle and advanced life the power of normal mastication, and by that means has not only made comfortable living a possibilty for those in declining years, but has undoubtedly added to the period of human life and usefulness. There are defects, it is —

12 PROCEEDINGS OF NORTH CAROLINA

true, but who is ready to admit that the period of stasis has arrived ? No it is our task to press — forward ; the past and the present call on us to advance. Let what we have gained be an impulse to something higher. Let us resolve not to be deterred, not to despair, not to listen to any voices, save those voices within us which tell us that such work cannot die. But as we go onward and upward we must not forget that " Pro- gress connotes obligation." In spreading and developing as it has done, the profession has incurred the obligation of its elevated position — noblesse oblige. There can be no high professional attainment without a true professional spirit. The essence and sweetness of life does not consist in what we shall eat, and drink, and wear, neither in great possessions, but upon nobleness of character and sympathy for our fellow man. That out of the most exclusive of all peoples, the Jews, should have arisen the one who first gave this conception distinct utterance is, to say the least, a notable event in the history of humankind. It was anounced for the first time in that most marvelous discourse ever given, the Sermon on the Mount : " Give and it shall be given unto you ; good measure, pressed down, shaken together and running over, for with the same measure that ye mete withal it shall be measured to you again." Until we recognize that there is but one humanity — that we are all parts of the one life — just as there are many stars, but only one light — that man is of necessity his brother's keeper, then and then only can we call ourselves professionally honest. For professional honesty is not the mere commercial quality that impels a man to pay his just debts and to refrain from cheating his neighbor, but it is that grander and nobler spirit which makes the truly professional man scrupulous to a nicety in everything touching professional and personal verity. The temptations to stray from the straight and narrow path of professional rectitude are more numerous and more strenuous than is generally supposed. When a young man is making a struggle for coffee, bread and an occasional morsel of pie, dollars look very large and the call to professional debauchery generally comes in the shape of seductive dollars. But if he has moral stamina, aye, if he has worldly foresight he will realize that it pays him in good coin of the realm to adhere to ethical principles and unflinch- ing honesty of action. Aside from the pecuniary and worldly profit of professional honesty, there is a greater advantage. There is no reward higher than that of the man who can look back at the close of a long life of professional activity, and see there nothing but honest work honestly done, high ideals lived up to — dignity of thought and action, and in spite of mistakes, failures and disappointments, activities that arose only from the honest desire to bestow upon everv man the " Jewel of Good Deed." It must be admitted that ability is the head and the strong arm of dentistry, but the professional spirit is its conscience. It is to it just what virtue is to society, and just as a blow to virtue is a stroke toward return to barbarism, so a blow at our professional spirit is a stroke toward that retrograde metamorphosis that would bear u? backward toward the trade of early days. Time was when the dentist who had learned better than his fellows kept his secret for the upbuilding of his own reputation. But it is not so today. The profession has become more catholic. It DENTAL SOCIETY 13 has risen to the point at which the experience, knowledge and progress of each must be used for the uplifting of all. The great dentist of today is not the man who simply builds up a splendid practice, however great his skill — but he, who carrying his own work on toward perfection, has at the same time done most in strengthening and elevating his professional brethren. He is important just in proportion to the strength which his ideas give to the upward movement of the group of which he is one. The soul that feels its individual responsibility to the sum total of life, can feel no greater happiness than in the thought that the world has been made a little better because it has sojourned here a while. The dentist with the genuine professional spirit can have no greater reward than that his profession has pushed an inch forward because he has helped, or to borrow " which men the words of Pagan Cicero : There is no other way by can approach to the gods, than by contributing to the welfare of their fellow creatures." So, since we are going this way but once, let us, as we pass through life, illuminate our pathway with kindness and friendliness. In the dental world, as in the larger world, there cannot be perfect unanimity of opinions, so while we may hold our own bravely let us respect a differing opinion when it is held with truth like honesty and sincerity. "Out of the differences of many, in the finally comes," but it must be a difference in harmony and not bitterness of strife. Above all things, charity should be cultivated for the shortcomings of our professional brothers. We are so apt obser- to judge them superficially. We see things from our point of that are our own. Let^us always vation ; we see them with eyes remember the exhortation of one of our greatest men to, " Be as lib- in your condemnation as eral in your praise as you may ; as slow you can." Strive to emulate the example of the best of all teachers :. " Whatsoever ye would that men should do to you, do ye even so the to them." Bear in mind that the best gift of man to man is our "Jewel of the Good Deed." And in remembering our duty to "Meccas patients and our co-workers, let us not forget our societies : of our minds and hearts that bring us thus together, where naught is mine and nothing yours, but all to us belongs." The formation of dental societies marks a transition from charla- tanism and empiricism to professionalism and science. They are the representation and strength of the profession in the states in which they exist. The number of members and their loyalty in any state society is the exponent of the influence the profession possesses for in that state for a good and efficient law, its enforcement and educational requirements. It is the prophet of the higher aspirations of the profession, to the torch bearer of a wider knowledge, the teacher of a nobler science — the inspiration of a better practice. it every And let us be loyal to it, working for it, and seeing to that to its glory. year we add something ^ " But, in our determination to give the Jewel of Good Deed we must not procrastinate, for the frail bridge of time on which we stand is gone from sinks back into eternity at every step we take ; the past only is ours, us forever — it is gathered in and garnered ; the present so here, when the surging waves are kissing the silvery sands in an ever enduring friendship, let us today begin the cultivation of that charity which thinketh no evil — the love without which all else profiteth nothing. 14 PROCEEDINGS OF NORTH CAROLINA

Annual Essay was referred to a committee consisting of Drs. A. C. Livermon, R. E. Ware and J. S. Spurgeon, who reported at a subsequent meeting as follows:

REPORT OF COMMITTEE ON ANNUAL ESSAY.

The committee appointed to consider the essay by Dr. P. E. Hor- ton, beg leave to report as follows : The essay is indeed " A Jewel," as its name implies. Carefully written, couched in elegant diction, containing many valuable suggestions, we commend it to the Association for careful consideration, and congratulate the writer for the many beautiful thoughts and noble sentiments therein contained. A. C. LIVERMON, Chairman. R. E. WARE, J. S. SPURGEON.

Dr. F. L. Hunt was appointed Chairman of the Committee on Publication. The regular program was then taken up and Dr. R. T. Allen read a paper on the subject of Prophylaxis, as follows:

PROPHYLAXIS.

In making my debut before the North Carolina Dental Society, an amusing instance of a young graduate of medicine presents itself to my mind in contra-distinction of my own feelings at this time. Having graduated from one of the leading Northern colleges, and feeling like a Solomon, he presented himself to the State Medical

Society as follows : " I Gentlemen, am Dr. B , a graduate °f College, and if any of the members of this Society wish to consult me about any difficult case in their practice, I will be glad to assist them." I have no new discovery to present, nor do I claim, as did the young physician, to be able to fathom all the depths relative to our noble profession, for I approach this ordeal with apprehension. My only ambition in presenting this paper is to recall some suggestions which I trust will be instructive and beneficial. If the attempt was made to trace the history of dentistry, we should be obliged to go back to the earliest Chinese Works on medicine. Eighteen hundred years before Christ, the art of medicine had made considerable progress in China, and a certain place more or less prominence was assigned to the care of the teeth. The earliest Hindu Works on medicine, fifteen hundred years before Christ, contain definite rules for the cleansing of the teeth. The ancient Hindu grasped an important fact which is now dawning on modern civilization, viz.: that the mouth — that gateway through which life's sustenance passes, and through which the germs of disease may enter the system — should be kept pure and clean, in order that the health of the individual may not suffer. Artificial teeth have been found in the tombs of the ancient Etruscans, dating as far back as six hundred years before Christ. DENTAL SOCIETY 15

Herodotus, the great Grecian historian, speaks of the attention given to the diseases of the teeth, and other writers claim to have found in Egyptian tombs artificial teeth made from ivory and wood, some of which were mounted upon gold plates. The history of ancient nations shows that the restoration of lost teeth by artificial substitutes was about the only form of dentistry practiced by the ancients. In succeeding generations has dentistry received attention — crude though it may have been — but not until the last fifty years has the profession made such wonderful advancement. Before considering the means by which teeth can be strengthened, and decay prevented, it will be well to consider some of the causes of caries, both exciting and predisposing. In studying the problem of etiology of dental caries from a his- torical point of view, one is struck with the tenacity with which in one form or another the belief has been maintained that the causes of caries were wholly or in part internal to the tooth. The earliest records tend to show that this conception of the cause of caries was the original explanation offered of the disease. The writings of Celsus in the first century betray his belief in the theory that decay of the teeth is caused by worms acting from within outwardly, a belief which survives among the Chinese, Japan- ese and Hindoos at the present time, and which was undoubtedly held by them from a remote period antedating the writings of Cel- sus. Later, the inflammatory theory, another aspect of the theory of internal origin, held sway, and even yet is not wholly relinquished by some who have noted the reactions in the way of structural changes presented by the calcified tissues of teeth when undergoing carious action. The modern studies of the etiology of dental caries began, strictly speaking, with the work of Leber and Rottenstein in 1867, when they published their important contribution entitled, " Recherches sur la Carie Dentaire," followed in 1881 by the paper of Underwood and Milles, presented to the International Medical Congress of London in that year and were practically completed by the work of Prof. W. D. Miller, of Berlin, published in 1884. The result of their studies established the following theories of caries : Bacteria capable of producing lactic acid are present in the mouth. This acid coming in contact with the teeth dissolves out in the lime salts from the enamel, and in this way starts the first steps in the process of decay. Then follows the destruction of the dentine, the decay proceeding along the lines of the tubuli toward the pulp until the entire crown has been destroyed. No one has yet seriously assailed this theory, and it is accepted by the profession with scarcely a dissenting voice. The acids producing bacteria find their chief source of nourish- ment in starchy and sacchrine foods, so in every plan of preventing caries, this fact must be remembered. Bacteria are unicellular masses of protoplasm, belonging to the vegetable kingdom, and are in many respects analogous to the higher order of plants. In the higher vegetable kingdom are countless num- bers of plants which, so far as our knowledge extends, are entirely useless, though harmless. 16 PROCEEDINGS OF NORTH CAROLINA

We have a small number of plants whose poisonous properties cause disease and death, but by far the greatest number in the higher vegetable kingdom serve a useful purpose and human life could not be supported without them. So it is with bacteria. Our present knowledge is unable to discover any office, useful or otherwise, which a vast number of these perform. There are others which, if surrounded by favorable conditions, will produce disease and death. There is also a long list of useful forms of bacteria which play an important role in the economy of life. Bacteria are so small that it is difficult to form an accurate conception of their size. A micromillimeter is a measure of 1-25,000 of an inch. If you divide an inch into twenty-five parts, one twenty- fifth will be appreciable to the naked eye. Keep in mind that it would take a chain of one thousand fair sized bacteria to stretch across that space and you would get an idea of the average size of a bacterium. Bacteria multiply by two methods, viz.: by fission or division of the original cell, and by the production of spores, which have been likened to seed of the higher vegetable world. These spores are really bacteria in a condition of arrested development. A single cell, it is estimated, may produce in twenty-four hours over sixteen million bacteria. In the mouth it is possible to control, in some measure, the rap- idity with which bacteria develop. This cannot be done by antiseptic mouthwashes alone. Rose has recently announced the results of experiments made with corrosive sublimate — the strongest of all antiseptics. In the experiments made by Rose, the number of bacteria in the mouth were estimated, and the mouth was washed with corrosive sublimate of the strength of one to five hundred. Nearly all the bacteria seemed to be killed, yet, in fifteen minutes nine per cent of these bacteria had developed ; in two and one-half hours seventy- five per cent of the original number were found in the mouth. It can be demonstrated that thorough mastication reduces the number of bacteria in the mouth. By the act of vigorous chewing they are dis- lodged from their resting places, mixed with the masticated food and carried into the stomach to be destroyed by the healthy gastric secretions. If the mouth is well cleansed and the food particles carefully washed out after each meal, particularly one which consists of food requiring prolonged mastication, bacteria will be found less abundant, and if the saliva is normal, and the teeth and mucous membranes are in a healthy condition, the development of bacteria will be greatly retarded. The saliva from some mouths makes a better culture medium than the saliva from other mouths, which points out clearly the fact that there are other considerations than the mere presence of bacteria which must be taken into account in explaining the decay of the teeth. An important consideration is the resisting power latent in the teeth themselves. That teeth differ in susceptibility to decay is shown when caries is produced artificially. If a dozen teeth be placed in the same tube and acted on by the same bacteria, some will show marked decay, while others will be unchanged. The same DENTAL SOCIETY 17

yield is true in the human mouth. The teeth of one patient readily to caries, while the teeth of others are extremely resistent, and if caries goes on at all, the process is a slow one. Some other causes of caries are lack of nutrition, lack of exercise and lack of surface polish, each being the result of civilized methods of selecting and preparing food. That dental caries is the result, as examination it is the curse of modern civilization is shown by the of the skulls of uncivilized races in the various museums where such collections are preserved. The primary causes which have led to the deterioration of the teeth have probably caused the narrowing of the jaw. It is because uncivilized races live upon food that is tough and which requires vigorous mastication that they have excellent teeth — free from irregularities and firmly planted in wide jaws. _ The Eskimos are noted for the strength of their teeth, yet their lives are passed under conditions far from hygienic. Caries is unknown to them, but frequently the teeth are worn down to the gum margin, showing the enormous use they must have made of them. From the habits and diseases which lead to irregularities and diseases decay of the teeth, it is but a step to the consideration of the of parts adjacent, and diseases of a general character which result from dental disturbances. Prophylaxis, or the prevention of disease, comes from a Greek word meaning " to keep guard before." Nature entitles every individual to as fine set of teeth as his ancestors possessed, just as every man is entitled to a living, but in to. both cases he is obliged to work hard to get what he is entitled Intelligence, high aims and energy will do as much in one case as in another, and unless there is a handicap of some unfortunate exer- inheritance, it is possible to have good teeth if the necessary tion is made. We are unwilling to go back to the life of our forefathers, even which if by so doing we could obtain some of the physical blessings they enjoyed, and which we admire. What then must we do ? Real- ize the immense benefit simple food and hygienic measures will bring about, be mindful of the truth that mastication will polish the teeth fact that inherited and stimulate healthy nutrition ; appreciate the tendencies may be overcome, or their effects minimized by the careful attention to the laws of health, and be not weary in well doing, for we know that all these things take time, and the fruition of our ambitions cannot be reached in a day. It is encouraging to know that the interest in this subject is increasing, and it is almost certain that the next generation will show a better condition of the dental organs than exist today. The control of caries is largely dependent upon the control exercised over environmental conditions. As the destroying agent is always external to the tooth, the one effectual bar to the beginning of decay is systematic change of tooth environments from bad to good. That caries is due to tooth environment is readily shown by the test of extraction. If we remove from the mouth a decayed tooth, having a live pulp or pulpless, it is a well known fact that decay in that tooth is arrested, and that further disintegration comes only with the lapse of years. 18 PROCEEDINGS OF NORTH CAROLINA

Does dentistry consist solely in the filling of a decayed tooth, the making of an artificial denture, or the insertion of a crown and bridge work ? Most emphatically it does not, and the dentist who has not a loftier idea of his profession than that is changing one of the noblest professions into a trade. The ambition and aim of the profession should be to prevent decay and its attending ills, by giving our influence to every worthy movement looking toward the betterment of mankind, morally, mentally, and physically, for, " If we have done so much in the spring of our professional year, in the season of its blossoming, what may not be ?" expected when the full time for fruitage shall arrive

DISCUSSION.

a paper as that Dr. Harper, Sr. : After listening to such the speakers of this Convention doubtless have their appetites whetted and are prepared to say something, because so many points have been suggested that there is something for every one to talk about and develop more than could be developed in a paper like that. We are very proud of this young man, and doubtless there is a bright future ahead of him. A young man with his first paper rarely covers so much ground, or covers it so perfectly, and rarely shows that degree of investi- gation that is shown in that paper. Is there a necessity for losing teeth? I would answer the question by saying both Yes and No. That there are thous- ands of teeth sacrificed every year because of the lack of knowledge necessary to preserve them, or for want of an application of that knowledge, there can be no question. That a very large per cent of teeth so sacrificed might be saved, there is no doubt. Now, I would emphasize this thought, that the prevention of diseases of the teeth is one of the things that ought to impress itself upon all of us, and let us impress it upon childhood, and from childhood to puberty, with a growing earnestness that will tell on our patients for years to come. If all could dread the necessity of extracting teeth as I do, and all would as gladly avoid it on every occasion, it seems to me that this would stimulate us to learn how to prevent the diseases that result in the destruction of the teeth. From the time that Jenner gave to us vaccination as a pre- ventative of small pox many men have been searching in every direction for that which will prevent diseases, and science has made wonderful progress along this line within a few years. Small pox used to be one of the scourges from which every- body shrank ; now there may be a hundred cases in the county fear it and we do not ; there may be a hundred cases in a town :

DENTAL SOCIETY 19

all the diseases known such and it does not stop business. In development has been made in this direction that it should the stimulate us to inquire how the diseases which result m what destruction of the teeth may be prevented. We all know many pyorrhea alveolaris is, and how to treat it and how prevent it- teeth are sacrificed by that disease. But how to cure, but easy prevention is better than cure. It is difficult to easily cured to prevent. If taken when it presents itself it is by proper applications of medicine and by whatever tends to keep the teeth clean. What a sickening sight to the eye it mouths is, and what a sickening effect on the nose, when some beautiful eyes, beautiful are opened ! Externally there may be nature or lips, rosy cheeks—whether made so by the hand of that of art I cannot say — but everything externally is sweet and nice, and then when the mouth is opened what a disappointment it is to us. Disease has laid its grip there. The timey application of medicine would change all that to a beautiful show of teeth — not a show of artificial teeth but teeth that were made in manufactory started away back in the days of Adam. On motion further discussion on this subject was post- poned until the following day at nine o'clock. The Secretary read the applications for membership and after the collection of dues the motion to adjourn prevailed.

Thursday Morning, June 30.

Pursuant to adjournment the Convention was called to order at 9 o'clock by the President. On motion the Convention proceeded to vote on the applications for membership, and the following were duly elected R. fH Squires, R. T. Gallagher, W. L. Ezzell, Carl P. Norris, H. C. Daniel, C. H. Banks, J. D. Carlton, I. M. Mann, F. E. Perkins, R. J. Morrison, J. H. Ihrie, Wexler Smathers, R. G. Sherrill, C. E. Smith, D. C. Mclver, John W. Carlton and F. W. Eubank. Drs. W. M. Culbreth and R. S. Cole were, on motion, and on the payment of two years regular dues, as required by Bv-Laws, reinstated as members of the Society.

Dr. J. C. Watkjns was requested to read his paper on "After Porcelain, What?" as said paper bears upon the subject of prophylaxis. Dr. Watkins read his paper as follows:

AFTER PORCELAIN — WHAT ? Dentistry, while one of the last of the sciences to receive attention, has grown very rapidly during the last fifty years. We look 20 PROCEEDINGS OF NORTH CAROLINA with peculiar interest at the methods of seventy-five years ago, and wonder how human beings could have endured the dental operations, and how they could feel that they had been benefited. But dentistry did begin to improve and develop, until we have reached the porcelain art, which with all its modifications, seems to be almost the ideal. When we think of how a tooth can _ be filled with porcelain. of bridge-work where we can replace lost teeth and defy the closest critic to tell which have roots and which are artificial — it does seem that we have surely reached the climax, but we live in a progressive age, and dentistry must continue to develop. We have reached, as it were, perfection in restoring lost tooth structure and now — what next ?

Porcelain will, for years, be one of our best friends, as it has a distinct place in dentistry, but it seems to me that the very next thing for us to do is to apply ourselves to the prevention of the loss of tooth structure. It makes little difference what you call it — prophylaxis, extension for prevention, or treating gums — we must check, and finally prevent dental caries and pathological conditions of the oral cavity. The question then arises, How can this be done ? In the first place, we must get rid of the idea of our cleaning teeth. We must impress upon the patient that he must clean his own teeth, i. e., by means of brush, powder, washes, silk, etc., dispose of all dental refuse before coming to the office, leaving for us the purely professional task of "removing salivary and other deposits," "treating mechanically and medicinally the gums," and "putting the teeth and conjoined parts in a healthy condition." When pathological conditions of the oral cavity are presented to us, the first thing we must do is to have our instruments in a decent condition. Every instrument should be thoroughly sterilized before it is used in the mouth. Even today, with our advanced ideas of dentistry, many denists are inclined to make fun of the idea of sterilization of our instruments, but, in a few years, we will be forced to do it. With our instruments in proper condition, we must remove all deposits and polish surfaces. In most cases, this is a big job, that cannot be done in fifteen minutes, or in an hour. During the recent meeting of the Southern Branch of the National Dental Association, Dr. M. L. Rhein, of New York City, told us that in one case it took him thirty hours to remove the deposits and polish the teeth. When we have the teeth and gums in a healthy condition, we should begin with our repair of lost tooth structure, but, always first remove the cause, before applying the remedy. After the teeth have been thoroughly cleansed with all deposits and stains removed, the next duty is to instruct the patient, and see that he keeps his teeth as you now have them. He must use silk, etc., removing all particles of food after eating, then with a "Prophy- lactic," or any similarly curved tooth brush, he should brush every surface of each individual tooth. If we can get a patient to follow these directions, we will have prevented pathological conditions of the oral cavity. Gentlemen, it seems like a hopeless task, but our only hope is with the children. We should get them early and see that they form the habit of brushing their teeth regularly. Some think we should begin with a child when about four years of age, but I think we should begin with the little teeth at an earlier DENTAL SOCIETY 21 period. We should see these children every month, and give them special attention each time.

A great many men say they do not like to work for children ; it does not pay. There never was a greater mistake. No one will advertise your good (or your bad) qualities like a child. Treat children well and they will be yours forever, but deceive them once or be unkind to them, and while they may come to you as long as they are obliged to by the parents, as soon as they can choose for themselves, some one else will do their work. We all know that most bacteria thrive best at the temperature of the body, and that the mouth would be an ideal place for their rapid growth. This being true, how can we hope or expect a newly erupted first molar or incisor to stay in a mouth for five or six years, amongst decayed teeth and microbes, without being injured? A good, well-developed, hard tooth could not stand the attacks of these forces, and certainly a newly erupted, undeveloped, tooth could not but be injured. When the incisors and molars are affected at ten or twelve years of age, it is only a short time until the others are decayed. To save the teeth and prevent decay4 we must get control of them before the permanent teeth are erupted. But it seems nearly impossible to give the child this attention. The average parent would think very strange of our calling in their child once a month, and furthermore they would think we were too eager for our fee, and we, certainly, could not afford to give them our time. So it seems to me that there is only one solution and that is to take the child's teeth by contract — and then the oftener we examined the little patient's teeth the better the parent would be pleased. This idea, at first, will seem too visionary and impractical, but we all have a few patients who will gladly take our advice as to their children, and it will only be a few years before they, themselves, will see how we have helped them, and gradually others will follow. Gentlemen, I realize that the suggestions offered in this paper will seem impractical, and can not be used, generally, but we are all working for the advancement of our profession and can surely do some of this painstaking work. Not one of us can work gold, amalgam, cement or porcelain to perfection — we all make many failures ; our crown and bridge-work is not what we would have it, but we all do have a share of success with the different classes of work. I venture to say there is not a dentist here, who can not get a small percentage of his practice, during the next year, up to this high standard. Then can't we, year by year, increase these good results ? While we hear on every hand about porcelain, and the ceramic art is the most studied branch of our profession today, while we have, as it were, reached perfection in restoring lost tooth structure let us look in the future and be among the foremost in taking the next step in our rapid advancement. Let us consider this question of prophylaxis — be abreast with the times, and fight to prevent loss of tooth structure, as well as to restore that which is lost.

DISCUSSION. pleasure Dr. Spurgeon : We have all listened with much to this paper, and I regret that I am not a speaker who can do 22 PROCEEDINGS OF NORTH CAROLINA

such a subject justice in discussing it. The subject of the paper does not seem to be very well denned because it intimates that we have passed a porcelain milestone. We have all arrived at the conclusion that prophylaxis is one of the most important fields in our profession. There is more to be desired and more to be hoped for for the teeth from the prevention of decay than from any other thing. For a good many years we have applied our energies to the prevention of decay, but only yesterday, while I was in Goldsboro, talking with Dr. Arrington, he made a statement with which I am prepared to concur. Discussing the remedies for the prevention of decay of the teeth he put, first, "cleanliness" and said, if we could succeed in removing all the organic matter that gathers around the teeth and keep them clean all the time we would have very little decay except on the surfaces of the molars and in poorly developed teeth. Then after cleaning the teeth the next thing is the proper manner of keeping them in that condition. Many disinfect- ants and antiseptics have been recommended, but Dr. Arring- ton's view is that the most perfect cleansing can be obtained by the use of a brush and water, and I agree with him. Many use different kinds of powders. I have seen many treat the gums with prepared chalk, and I believe that is responsible for diseases of the gums. In this paper there are many valuable suggestions, but there is one point on which I differ with the author, and that is in regard to contract work. I do not think the medical profession or the dental profession should encourage contract work. It is a wrong principle. I think with contract work we could not get the same results that he has pointed out. I would take a child as he suggests and have him come to me every thirty days for a year, and that child will depend on the work you are going to do for him, and will feel no responsibility himself; but unless the instructions we can and should give to our patients are so impressed on them that they will be followed out, our work will avail very little. If I have been of any benefit to my patients it has been in the instruction I have been able to give them and that I have induced them to carry out. In fact, I frequently say, "this instruction I give you is worth more than the work I do — the work is of little value unless you carry out the instruction." I agree with him that our hope is with the children, but unless they follow our instructions we will never get the desired results. I do not believe the contract plan is best. In this DENTAL SOCIETY 23

labor persistently applied. By field it requires a great deal of instructions getting a few of the patients at a time to obey or three years. we will be very much gratified in two sterilization. Now the second proposition in this paper is Now do we do that? And the next question is, is it neces- Society sary? A few years ago I heard in a meeting of this something about keeping things in order. The idea of the paper was, when we use an instrument put it back in its to proper place and never take it out except when we want sterilization about an instru- use it. Now, there is very little like ment used like that, and I see some here whom I would sterilization to hear on that subject. If it is necessary to use are in the later we must do it. We all work for patients who stages of tuberculosis — patients who are in different stages of specific diseases, and if there is danger of getting unhealthy matter on the handles of the instruments it is time we should use sterilization. I must say that I do not use sterilization, but I do use cleanliness. I thoroughly cleanse all my handled instruments. After having used them I never use them in another mouth without giving them a thorough cleansing. I had the pleasure of being in Dr. Watkin's office a few weeks ago. I do not say it to specially compliment him, but the suggestions were more favorable for getting good work done there than in most of the offices I have visited. His office there every was in perfect order ; sterilization was being used day, and suggestions of that kind were very plain. But is it necessary to sterilize the instruments? This is a question of great importance to us because if the instruments are often put through this process they will not stand many months on account of rust or temporarily giving way. If it is necessary we have neglected it too long; if it is not necessary, we cer- tainy do not want to go to the trouble of doing it. We are face to face with this proposition. The time is coming when something must be done. The leading members of our profession are using sterilization, it is urged on all of us, and if it is necessary the sooner we get at it the better for us individually and collectively.

Dr. Carr : The most of us heard the paper read last night by Dr. Allen. I think in order to discuss a paper intelligently it is necessary to have seen the paper first. I obtained it and have read it over. I was much interested in it when it was read because it follows out the teachings of Dr. Miller, whom we all honor and who says things that we regard very highly. He is considered an authority on bacteria of the mouth. It is 24 PROCEEDINGS OF NORTH CAROLINA

a subject of the utmost importance. Prophylaxis, or oral hygiene, is the subject of all others pertaining to dental surgery, and includes the subject Dr. Spurgeon has spoken of. If we can keep the teeth clean we have done more than we can do in any other way. The means of preventing decay of teeth is something that must be studied very carefully. To commence with, the child will not do — you must commence with the mother before the child is born. To say that teeth have retrograded for the last fifty years is to put the case mildly. They have retrograded to a very great extent. In this civil-

ized age we have our food all prepared for deglutition ; it is not difficult to chew it except sometimes in the case of beef stake, and so our teeth, on this account, are getting to be of no use to us. I prophesied some time ago, and I believe it is coming, that the time is coming when toothless children will be born into the world. This may be a long way off, but there is something in it. Dr. Allen has made several good points in his paper, the truth of which cannot be gainsaid. We know from observation that mouths that are not kept clean necessarily breed bacteria, and the lactic acid, if secreted, will certainly dis

solve the lime of such teeth. And how to prevent it is the main thing to be considered. To my mind the use of alkaline preparations together with thorough cleansing with water and a brush is necessary. In a healthy mouth, in the case of one who uses his teeth all the time, as in the case of a user of tobacco, the salivary glands are excited and the follicles pour out their secretions, and there is no necessity for any mouth wash that is distinctly antiseptic, or of any tooth powder except some powder that will clean off the stains from a child's teeth. The mouth that is kept clean cannot breed bacteria — they live only in unhealthy mouths — they cannot propogate elsewhere. There is a certain war going on between different forms of bacterial life — one destroying the other, and the man whose system has always been pure and clean will never contract any contagious disease. He need fear not a small pox epidemic ; and the same applies to the mouth, and^to the teeth — there is no possible way for decay to take place in his mouth. When I say the oral cavity is not clean, I mean the salivary glands and other glands are not clean. Our forefathers' teeth did not decay because they lived more sturdy and rugged lives than we do. Any organ of the body that is not used becomes functionless and nature does not tolerate this anywhere. Nature wants to find an DENTAL SOCIETY 25 antagonist for the teeth, and if it has no other antagonist it will strike the gum on the opposite jaw. Nature will not tolerate a functionless organ. There is also a long list of useful bacteria which play a useful part in the economy of life. There is another good point in this paper, agreeing with Dr. Miller: Bacteria, like the lowest form of animal life, Monera, propagate by segmentation and propagate very rapidly. They are so infinitesimal it is hard to realize how rapidly they multiply. We cannot use a mouth-wash strong enough to destroy them without injuring the mouth. Some mouth washes are recommended by the newspapers. They say it is a pure gas, and they offer a thousand dollars reward to any one who will find a germ that it will not destroy. Now, this is the ideal antiseptic for which we are looking and longing, but whether it is what they claim for it I am not prepared to say — I do not know. It is a patent preparation in one sense, though they claim to tell how it is made — from the best oxygen producing substance. But a wash strong enough to destroy bacteria will destroy the tissues of the mouth too. Unless the saliva is healthy and the other secretions are healthy, bacteria if all will not. So in will propagate ; healthy and right, they the use of tobacco — I think the only damage to the teeth from the use of tobacco is the mechanical wear, and such teeth rarely ever decay. I think most of the gentlemen here will bear me out in this, because the secretions are constantly changing, and the muscles are constantly exercised, the glands have something to do, and the secretions are necessarily healthy. Many teeth these days do not have sufficient resisting power. We are living too fine, and our food is not the right kind for healthy teeth — it is prepared improperly. After being cooked it should be prepared for the body in our mouths. All teeth are composed of the same proportion of different substances, and as the patient growr s older the teeth acquire density and can better resist the action of lactic acid. Many seem to think if they polish the teeth it will stimulate a healthy things nutrition ; but let us not be weary in well doing, for such take time. Teeth will not suffer in a healthy environment. If we remove a decayed tooth it is a well known fact that decay in that tooth is arrested ; and why so? Because it is not subject to the action of bacteria. We have spores in the atmosphere, and bacteria multiply in that way, and why do they not grow in a removed tooth? Because they must have moisture to live on, and they find it in the mouth. We should prevent 26 PROCEEDINGS OF NORTH CAROLINA decay and its attendant ills by attending to everything else necessary to a healthy life. The paper read by Dr. Watkins was also a good paper, along the same line, and deserves some consideration. There are two points I want to speak of referred to by Dr. Spurgeon : Dr. Spurgeon supposes that the use of prepared chalk is responsible for recession of the gums in many instances. I do not believe that is true. In prepared chalk I think we have one of the best remedies for neutralizing the action of acids upon the teeth, whether from lactic acid or bacteria. It neu- tralizes the action of the acids, making it perfectly harmless without wearing the teeth away. The constant use of the tooth brush, even if used with water, will wear the teeth away. I know a gentleman in Durham, who was in the hands of one of the best dentists in America, and who had a tooth worn down to the pulp from nothing else than the free use of a stiff brush rubbing against it. The gums have not receded appreciably, but he has worn the membrane with the brush in places and the gums have left that point. But what we term recession of the gums is where we find tartar collected from the serum of the blood. This is generally the cause of recession of the gums. But brushing the gums when chalk use of is used does not cause the gums to recede unless the small too stiff a brush and used too hard. And we want too a brush. If you have a little brush and your mouth is full of water you cannot cleanse the teeth; you can do it better with a big brush. especially I believe in the sterilization of instruments, and where you touch any of the soft tissues of the mouth. It might not be necessary in excavating, or cutting into tooth sections, but when we touch any of the soft tissues of the mouth we must have the instruments sterilized. I want to tell you about a which little machine by which you can make formaldehyde gas It will destroy bacteria. It is a formaldehyde gas generator. will take only five cents worth of wood alcohol from which generator and put the gas is made. Put this alcohol in the office when you fire to it, then open all the drawers of your the go home at night. It will burn for four or five hours and whole room will be thoroughly fumigated and your instruments be thoroughly sterilized. I can give you the address so you can buy one of these generators. Dr. Turner: There are so many subjects included in the But realm of these papers, the last of which I did not hear. of opinion about the I do not think there is any difference difference necessity of keeping the teeth clean, and not much :

DENTAL SOCIETY 27 of opinion as to the manner. I do not suppose any gentleman here doubts the fact that where the teeth are kept clean there is no decay. We all believe that decay is the result of disintegration by chemical agents which are supposed to be produced by certain bacteria. I do not suppose that question will interest us very much because we have read about these matters and are familiar with them. But as to the sterilization of instruments — it seems to me that that is a settled question. Nobody can doubt it when they come to consider that surgeons have been able to perform such wonderful operations by the aid of modern antiseptics and sterilized instruments. We all know that that is the means by which they are able to cut open, or cut into a cavity and get into the diseased parts. Nobody doubts that sort of thing. I think it is well to emphasize these things and take an account of stock. I did not suppose there was any dentist who did not think it necessary to keep his instruments clean — absolutely sterilized. I think Dr. Carr is mistaken in supposing that there is no sterilizing agent to effectually destroy bacteria. If that be true we have all been laboring under a delusion about these things.

Dr. Carr : We have been laboring under a delusion.

Dr. Turner : I am open to conviction. I am sorry I did not hear the paper read, for I know he carefully prepares his papers. One thing strikes me as a very important factor, and that is the prevention of pyorrhea. I have a good friend in one of the Southern states, who has made a specialty of pyorrhea, and his neighbors in the profession here say he pro- nounces everything pyorrhea. Now that is not very far wrong — I do not mean literally everything, but I mean this When a patient comes to you for treatment that matter ought to be looked into, it ought to be looked into more closely than the average practitioner does, for the reason that we believe in pyorrhea. Of course there may be an inherited tendency to disease, but in that case it is more important still to look into it. Decay can be controlled much more easily than pyorrhea, for when it comes to a certain stage it is very difficult to handle. One other thing: The average practitioner, instead of attending to the points presented in these papers, seems to think that he is not paid for this sort of thing. He seems to feel that he is not appreciated — no appreciation of the service rendered to his patients by simply protecting them from greater trouble. That is the mistake made by the profession. It is true that many of our duties are mechanical, but we should not consider that we are to receive pay for all we do. 28 PROCEEDINGS OF NORTH CAROLINA

So the average dentist ought to consider, when a mouth is put into his care, all the points that might affect that mouth, not only the decay, but other things. I have had patient after patient come to me and say, "I have just been to see my dentist and he says there is nothing the matter." I do not say deposits always produce pyorrhea. There are some cases of pyorrhea that seem to have been produced in a mysterious way where the gums indicate that a pocket has begun but there is no appearance of deposit. It is a mistake to suppose that such a case needs only a little injection. The most successful practitioners who have made pyorrhea a specialty and are experts, will take an hour and a half to two hours to treat one tooth, which seems extravagant to one who does not pay much attention to it. You may think, and the patient may think that you have pulled off some of the tooth substance, but it does not make any difference if you do pull away some of it — it is no disadvanage to the case. I say the average practitioner is not to consider that he is simply employed to do mechanical service,, but to keep the mouth of the patient in the best possible condition.

Dr. Wyche : I am sorry that Dr. Harper is not here to tell us something more about this pyorrhea and the prophy- lactic treatment for it. If we could know when pyorrhea begins and how to treat it — that is what we want. I dis- agree with Dr. Turner that scraping the teeth as some do, makes no difference. If the peridental membrane is gone it will never come back any more.

Dr. Turner : That is the experience of experts.

Dr. Wyche : If it is gone from the tooth half way it is gone entirely — I mean as far as a permanent cure is concerned — not a half cure. I would like to know the treatment of pyorrhea in its earlier stage and also how to treat it in its later stages. Dr. Bland: Dr. Turner says some one calls everything pyorrhea. He ought to be a better diagnostician than that.

Dr. Turner : I say he was accused of that — the boys accuse him of calling everything pyorrhea.

Dr. Bland : I know that pyorrhea covers a multitude of sins, but not all of them. I think we ought to differentiate

between different types of pyorrhea ; some which arise from gouty natures and others which are local in their nature. Of course it is not practical to treat them both in the same way. There is to some extent a preventive treatment, referred to in the paper on prophylaxis, such as the proper use of the teeth, cleaning the teeth, willingness to be taught, taking DENTAL SOCIETY proper food, and keeping the person in good condition. A'l primitive people never had pyorrhea or decay or any of these diseases which arise from what President Roosevelt calls "strenuous life." Have the teeth kept clean and the tissues in a healthy condition, and pyorrhea and decay would be kept out. That is true of prophylaxis. Dr. Crenshaw: Those were two excellent papers. Last night when the paper was read I thought about what the toper said about whiskey; he said, "it was all good whiskey," and the way he differentiated between the brands was " by saying, they are good, better and best ; there is no bad." There is no bad in these papers — they are all good and complete. On the subject of prophylaxis I am of the opinion, as I think we are all coming to be, that our practice must turn a good deal upon the cleaning and maintaining the cleaning of the mouth and teeth. You cannot do much with it until you get into the true inwardness of it, so to speak — of the cleaning of the teeth. If you could see Dr. Smith, and see with what infinite pains he cleans every tooth you would get inspiration from him. This is one of the biggest questions concerning the practice of dentistry. Now as to keeping his teeth clean, the patient has a contract on his hands. It is a very difficult matter for him to keep them clean as a dentist would clean them and keep them clean. I am loath to give up the idea that any of the mouth washes are inadequate to the demand made upon them. I think I know of something that will work all right : Recently I got hold of a bottle of High- land Scotch whiskey, and it is a good mouth wash. I have recently been using that as a good mouth wash. I have tried to introduce it to Dr. Alexander and he has consented to use it on his teeth. He has a decayed tooth and he put some of that in it and said he felt something crawling in his mouth and he put in his forceps and caught hold of the tail of a microbe and hauled it out and said the thing had a mouth in it — he said he could see it. I am very much interested in the question of prophylaxis, so much so that in our school we have inaugurated a require- ment that each student shall take a patient or two and handle their teeth all through the session. We require the students to come to the office once or twice a week and go over the teeth of these patients. This teaches the student what he needs to know, and teaches the patient what we mean by keeping the teeth clean. It accomplishes a great deal of good. As we come to understand the importance of this sub- 30 PROCEEDINGS OF NORTH CAROLINA ject we are going to better preserve and protect the life and comfort of our clientele, and are going to make ourselves more valuable to them even if it puts the profession out of business. Dr. Jones: I enjoy these discussions and I enjoyed the papers. I do not know of a more important subject. It is true the discussion has gotten a little off from prophylaxis, but we are learning the result of neglecting the teeth. If in reading these papers it will impress upon our minds the importance of teaching our patients the means of cleaning their mouths, we will have accomplished a great deal for them and for the profession. We need not go out of business in caring for their teeth, but that man who teaches his patients to cleanse their mouths has done more for them than to fill a few teeth. When a patient comes to us with a decayed tooth we fill it and then are apt to think we have done something, but afterwards the, patient so sadly neglects his part of the performance that our work seems thrown away. If these papers impress upon them the means of doing their part of the work the profession will have accomplished much. You cannot teach a patient too much about this. How many of us teach them the importance of cleanliness of the teeth? And if their teeth are not clean perhaps no one is to blame for it but ourselves. Take three-quarters of an hour and put the teeth in good condition, and then charge properly for the work done. Those of us who were present at the meeting of the Southern Branch in Washington and heard this subject discussed were benefited — I know I was. I do not think too much attention can be paid to it. Dr. Smith has a clientele that we cannot boast of in this State. They are people who can go once a month and have their teeth thoroughly cleaned. If we could do that we would have less filling to do, and we would not be losers for we could charge in proportion to its value.

Dr. Frazier : I have been favorably impressed by these papers and these discussions. We who are the "Benjamins" of the profession — it is up to us to practice prophylaxis. The medical profession has been enforcing it, and now it is up to our profession to push our side of it. I do not like the word "contract" as used in this connection. I am willing to do a little missionary work, but not to undertake too much by contract. I have contracted to do certain work for certain persons, but I would rather do a good deal of work in a missionary spirit than by the contract system. Dr. Foster: I do not know that I can add anything to interest you, but I want to express my pleasure to have been DENTAL SOCIETY 31

here and to have heard the papers and those most instructive and interesting papers by the President and Essayist. I did not hear Dr. Watkins' paper this morning and am sorry I did not. I came on the train yesterday and Dr. Allen said he was going to make his debut, and I have wondered since last night why the North Carolina Dental Society stands out in

such bold contrast with other State Societies ; it is because you encourage your young men to write papers and give a grade to their papers; it makes them go forward and will make them the best men of today. It is listening to such papers that makes us all feel that it is worth while to go to a dental convention. These papers are real character builders. They inspire us with the highest ideals and make us feel that we all want to do something and do it better. Have you ever considered that dentists are character builders, and that their characters are read in the mouths of their patients? The palmist tells us that we have an inherited and an acquired character. Whatever truth there may be in it I cannot say, but he says that in our left hand we have inherited character and in our right hand acquired character. Phrenology sees character in our heads and in our skulls physiognomy sees ; it in our faces, but the dental profession finds its character in the mouths of its patients. It is such papers as these that inspire us to higher ideals and to better work. They make us feel that we want to do something for mankind, and if not another paper is presented I shall go away feeling that I have value received. If one has a clean mouth his teeth do not decay. We do not consider this as we should. Patients who chew gum have clean mouths because of the constant mastication — it washes out the bacteria. Dr. Turner brought out the question. And there is no doubt about this being a great subject. While we are on the subject of prophylaxis, which is not a simple cleansing of the mouth, but includes the prevention of disease — I think it is one of the greatest questions of today. It should command more of our attention. I am glad to know that prevention is getting into it and that there is going to be more of such work done. Our field extends further than simply the mechanical cleansing of the mouth. It is a part of our work to prescribe therapeutic agents for the cure of the general system where we seek to control diseases of the oral cavity. If we have a lack of oxygen other remedies can be used. Quinine is good, and other substances such as iodide of potassium and arsenic ; and we might find a number of remedies which are valuable in our hands in building up the sys- ;

32 PROCEEDINGS OF NORTH CAROLINA

tern and overcoming these troublesome deposits. We want to do more than mechanically cleaning the mouth, and until we get there we are not going to reach the ideal which we should reach in the practice of our profession. Dr. Ware: There is no subject more important than this. The fact is we cannot spend too much time on it. There are two points brought out in this discussion that are very difficult to overcome; one is the proper cleansing of the mouth; and the other is this strenuous life of this modern civilization. Are people coming to us for cleansing of the teeth? When they have the tooth ache they want us to examine the tooth if but how few of them want us to clean their teeth ! And they do not ask us to do it we are liable not to do it, but are ready to go ahead and put in a filling, which is more pleasant than cleaning teeth. I think the very first duty we should perform for the patient is to cleanse his teeth and put his mouth in a healthy condition and then go ahead with the operation. The patient does not realize that his teeth need cleaning — he has this calculous deposit, but he does not know it. Not being aware that it exists, how shall they know it unless we tell them? If this cleaning has been neglected for a long time you take your instrument and knock off this deposit and the patient thinks half his tooth is gone. And then this strenuous life — how are we to overcome it? American civilization is going on and we cannot prevent

it. People are living too fast — try to accomplish too much in one day and it tells on the teeth — has a great effect on them. To prevent decay — that seems to be the great thing both in the medical and dental professions. We need to treat the teeth not only after they are diseased but in order to prevent disease. There is more pyorrhea existing than we have any idea of. We do not see it — do not find it out in its incip- iency. And though we cleanse the teeth and show the patient the necessity of keeping them clean we cannot get him to come often enough to keep them clean, and then pyorrhea will begin. There is only one class of patients whose teeth never

decay ; they are the habitual tobacco users ; but there are others whose teeth are decaying by these deposits, and pyorrhea is there before they are aware of it. If we could induce them to come to us we could help them. Sometimes a decayed tooth is a good thing, because then the patient comes to us and finds out that pyorrhea is already begun. There is one thing which we should insist upon, not only taking away the deposits, but putting the mouth in a healthy condition, and giving them instruction in regard to this. One important DENTAL SOCIETY 33 thing is the massage treatment of the gums. This has not been touched upon this morning. I believe it is one of the very best things the profession has found for the healing of pyorrhea. How often we see teeth in an unhealthy condition and we say to the patient use the brush up and down, though we often forget to tell him how to use the brush, and we fre- quetnly forget to tell him to brush the gums also. I think we ought to instruct him how to give the gums massage treatment by using a silk handkerchief and bathing them in cold or salt water and rubbing the gums daily. It may make the gum bleed a little, but it will get harder and firmer, just as our hands get harder and firmer by constant use ; the gums will grow hard by pressure and rubbing in this way.

Dr. Osborne : I do not know that I have anything to say on the subject of prophylaxis, but I took some notes for my own benefit. It seems to me that I am not up to this business, nohow. Prophylaxis — that means killing out things before they get away, or something like that. Well, I think it is the best thing we can do to teach our patients to keep their teeth clean. I think a good many of you have a better opinion of this business than I have. Some people think that if they take the necessary precaution about typhoid fever they will never get it ; but they will get it just the same, and don't you forget it. Some one spoke of dentists going out of business because they will not be needed if we can teach the patients to keep their teeth clean. He is very badly mistaken. So some one said this automobile business would put the horse out of business, but the old man says he has got to be here yet. I can't discuss this question right on the jump. Prophylaxis —that means killing bugs. I have good eyes, but I have never seen one of those bugs. The truth of the mater is you have got to use costly apparatus to look at these gentlemen. If I should meet one of them in the street I don't know whether I should know him or not. They first called them bacilli, and then bacteria, but we used to call him parasites. You cannot see them without special instruments, but I haven't got the instruments, and can't discuss the question. If a bug wants me to take notice of him he must grow up to some size where I can deal with him. I had a little experience last night with some that were big enough, but that species never takes much argument. If a bug will grow up where I can see him I'll manage him, but where you have to buy a thousand dollar instrument in order to see him — I can't do that. No, gentlemen, there is no use denying it — there are many who are not going to see what you see. They will not keep their teeth 34 PROCEEDINGS OF NORTH CAROLINA clean. You might as well sing Psalms to a dead horse as to tell them to keep their teeth clean. I have not yet got to the place to find out whether good teeth is a matter of organization or, as some say, of surroundings, but it looks to me like a pretty good argument that it is a matter of surroundings. One says if you keep the teeth perfectly clean they will be all right; that is according to my idea. One fellow said he kept the teeth perfectly clean and there was no decay. That may be so, but there is a difference in teeth from an organization standpoint, but cleaning the teeth is one thing, and the condition of the mouth is another. We find teeth decaying in the mouths of persons who keep their mouths clean and in good condition. I don't know the cause of dental caries — that is way down to the beginning of it — we have not got there yet — I don't know whethr it is a matter of organization or of disease. There may be too much argument on both sides — I am not going to dwell on it. I don't like the contract system. If we get hold of a man it is not to get hold of his money, but I tell you we don't! have to miss a fit of that kind. You may tell a patient he must do this, that, or the other thing, but you will see him only when he has the tooth-ache ; that is my idea of it. Tooth powder or paste has no business in the mouth. If the patient will use the brush all right his teeth will be all right, but nothing should be used that will destroy the tissues of the mouth, for if they are destroyed there is no further use for the brush. " Scraping the teeth "— that tickled me. One man said that one fellow scraped them thirty hours. Wouldn't that be nice! I would "call off" if I had to scrape thirty hours. Another said scrape them three or four hours — I could scrape two or three of them clean in two by that time. I believe that is all.

Dr. Allen : I think it is the duty of this Society to look after a class of children in North Carolina that are deprived of the privileges of home and parents — we ought to teach them these things. I refer to orphans in our Orphan Homes. In the various orphanages of this State there are about one thousand children that receive education and clothing and all that the management can give them, but they cannot give proper attention to their teeth unless they have aid from this Society, and I think it is the duty of this Society to make an annual visit to each of these institutions and look after the teeth of the children. It was my privilege about four years ago to work about five days in one of these institutions, and I want to say if any member of this Society will do a similar work DENTAL SOCIETY 35 and does not feel amply paid for the time he has spent away from his office looking after these children, he has a mighty bad heart in him. Dr. Osborne: In reference to this: I did what he says he did. I went to one of these orphanages and I am sure I am a better man than I was before. I was pretty good before, but that, and I am better now. It is no harm to do such work as I think it is up to the Society to do this. If there is anything that pulls upon our heartstrings it is the chidren that are orphans. Go and spend a week with them and you will come back with a heart in you. I think we ought to look after them. Raleigh have no Dr. Everitt : The two refuges located in be others in cause to complain in that regard ; but there may the State needing such service. Dr. Osborne: But these gentlemen cannot give their time to these orphanags and to the children throughout the State. The children are very thankful for what they do, but that is not A in the alphabet. In the institution that I was in only one man had been there before me. Of course these institutions get help from resident dentists but they ought to get service from other dentists. From my experience with these children you cannot have any better. suggestion, and Dr. Crenshaw : It pleases me to hear this with experience along that line. I think it corresponds my _ the schools of Atlanta" intend to keep up with looking after the teeth of the children in the Orphan Homes. I have never seen in all my life just such fortitude as is evidenced on the part of these orphan children. I have not seen any children in the best regulated families that compare with them at all in their behavior in the chair. Would it not be well for this Association to take some formal action in this matter to look after the teeth of these children and not leave it to A, B, or C to go as the spirit may move him? I suggest the nomination of a number of dentists — half a dozen or a dozen, or a dozen and a half, or any number you may decide on, and let each of these give one, two or three days to this, that or the other Home, and let the institutions feel that the men who are there to do this work are vouched for from some responsible source such as this Society would be able to give them, and that it is not the enterprise of two or three enterprising dentists who would give their services, but men whose services would be thoroughly acceptable and are vouched for by the Society. I think there is hardly any work that we shall look back upon with more pleasure when we come to die than what we have 36 PROCEEDINGS OF NORTH CAROLINA done for such children. I hope these suggestions may take some effective shape.

Dr. Osborne : The distance one of us may be from one 01 these institutions has nothing to do with the question, because the railroads will pay your fare there and back as they did mine.

Dr. Everitt : Dr. Crenshaw's suggestion is a most valuable one. Any member who can spare the time to go to these Homes and give one, two, or half a dozen days to attending to the teeth of these children, with the endorsement of the Society or of its president, would do a very good thing and would give valuable aid to the superintendents of the Homes. If a dentist goes who is not acceptable the superintendent does not know his standing in the Society, but when he is vouched for by the president of the Society and would go and spend a week or any length of time — the Pres. or Sec. could com- municate with the superintendent and say that such a man is a good member of the Society — he would make his visit to the Home and would get proper attention. This would be of very great benefit to all concerned.

Dr. James : But suppose there is selected from time to time from this Society, five, six or a dozen men to attend to this — they might not be sufficient. Why not endorse and authorize every member, and let all feel the responsibility? Dr. Crenshaw: That would be entirely acceptable. I did not mean half a dozen men, literally. I have no doubt that with the endorsement of the Pres. of the Society any man would be acceptable.

Dr. Watkins : It has been said here that we should teach our patients to clean their teeth. That is true ; if they wait until the gums are slightly diseased and we then remove the deposits and leave them clean, and show the patient how to keep them so they will appreciate our work more than if we take the brush and clean the teeth ourselves. That same party who told us he worked thirty hours told us a little later that he did not work for anybody for less than $10 an hour.

In regard to contract work : I do not believe in it — to be frank — but we must in some way get close to the children. Dr. Spurgeon suggests that the children will depend on the work we are doing and will not feel any responsibility themselves. But if we go to see them once a week, or once in six weeks, and we notice that the teeth are not in a good condition on one side of the mouth, and we say to them, "You have not been doing as much on this side of the mouth as on the other DENTAL SOCIETY 37

— you better use this side of the mouth a little more," and in this way teach them to take care of their teeth — if in this way we make friends of them, they will come to our offices, and if we can get them to take care of their teeth we will accomplish much more than we do now. I do believe in sterilization. It seems to me very necessary that the surgeon should boil his instruments and thoroughly sterilize them. It is necessary for us. When I have seen so many mouths diseased I have wondered whether some of them might not be caused from infection from unsterilized instruments as well as from hereditary diseases. Paper passed. Dr. J. A. Gorman read the following paper on "Something 'on' Porcelain."

"SOMETHING 'ON' PORCELAIN."

Since porcelain has been adopted as a legitimate and permanent feature of the dental practice, it is but natural that because of its likeness to the tooth structure its first and main claim upon our attention should be the restoration of lost teeth in the anterior part of the mouth. Now that it has come to stay, we must look into the different ways to make it stay in the mouth. We pick up the Journals each month and see the same old story time and time again, " How to make them," yet nothing is said about how to aid them to stay, only by the cavity preparation, use of pins and etching. They say but little about the latter two. We can all make cement adhere to the tooth, but getting a perfect attachment of the cement to porcelain is another thing. Dr. C. H. Land, of Detroit, has invented a Cement Media by which thin veneer of porcelain may be secured and permanently cemented, also that inlays, cartoons, crowns and such things be cemented into cavities without restorting to pins and posts. Enamel facings can be cemented to bridges in the mouth. He claims the retaining force to be greater than the breaking strength of its entire mass. Dr. W. B. Ames, of Chicago, is due credit of first experimenting with his cement powder mixed with porcelain and baked as a media, so it was from him at the last meeting at Washington that I got the idea, and I have been experimenting along that line. My best results were obtained from Ames' Cement Powder one part and S. S. W. porcelain two parts, Ames' Powder one part and Brewster's Porcelain three parts. I want to say that with Harvard Cement I could not get anything as a media. From Johnson & Lund's Cement one part to Brewster's Porcelain three parts, I got a fair result, while from Archite (which I believe is nothing but ground glass, as I took some plain powder and placed it in the furnace and could see nothing on the Platinum), I could not do anything, but by adding a little Archite Powder mixed with any of the higher fusing bodies, aids the attachment of the porcelain to the platinum. Now the advantages I claim for this mixture over Dr. Land's 38 PROCEEDINGS OF NORTH CAROLINA

Media is that it can be placed in the matrix and baked before the body is placed in, while with the Land's Media it is baked on after the matrix is taken off. To sum it up: 1st. The importance of getting a perfect attachment of cement to porcelain. 2nd. The difficulty of etching with hydrofluoric acid, and the chance of destroying the inlay. Also the great risk of roughing the porcelain with stones and disk. 3rd. Doing away with the use of pins in inlay for its retention. 4th. Lessening the chance of exposing the nerve from the depth of cavity for retention. One having once familiarized himself with the possibilities in the use of this mixture, he has opened the way for far more satisfactory work than was possible before.

DISCUSSION.

Dr. Carr: The subject of porcelain annealing is one that the profession has not had a great deal of experience in so far, except in the years gone by. I have not had much experience in it, and it has not been in use much, but I have come to the conclusion that it has its own place in dentistry, and I believe it is here to stay. I attended a demonstration not very long ago in a distant city and saw a great many cavities prepared but in a great many instances I could not believe the annealing was of benefit; especially in the case of teeth that had been cut away a good deal there was no apparent attachment after the cutting of a large tooth — simply the close contact of the porcelain with the bottom of the cavity, and the cement holding it. Dr. Everitt: Porcelain doubtless has its definite place in dentistry and has come to stay. I have seen some beautiful work on that line. One of the members of this Society, Dr. C. A. Rominger, who has been one of our most accomplished practitioners, has done some of the most beautiful work of that kind I have ever seen. I have had very little experience with it. I have done a little practice with it, but I find it takes time and practice to make perfect. But do not get discour- aged, young men, the first time you try it. I remember the first bit I put in came out in two days, and I spent two days in putting it in again, but my failure made me determined to succeed. There is much to be learned on that subject, but I am not in a position to give you any points. If your matrix is made with Williams' rolled gold — I can make an impression much better with gold than with platinum, though some get good results from platinum. The great trouble about it DENTAL SOCIETY 39 is a great many men will try to do this work and will carry it too far, putting it where it should not be placed, and failure is the result. Dr. Gorman, in his paper, alluded to some specimens he had of porcelain with cement, and I think he has those specimens to exhibit at his clinic.

Dr. J. D. Whitakers paper being on a similar subject, he was requested to read it at this time, and he read as follows:

PORCELAIN INLAY.

So much has already been written and said about this subject that I shall not attempt to go into the detail of making a simple inlay rilling, but will lay stress upon little points which I have picked up from various places and people ; these points have been of service to me and I hope that they may be of service to some one here. We will first consider when an inlay is called for, secondly the cavity, thirdly the matrix, fourthly the baking, and lastly the placing of the filling. An inlay is to be used when the tooth calls for cement but we wish something more permanent ; in the teeth of people too nervous to stand gold ; in cavities that are exposed to view ; and in large cavities, such as are found in molars or biscupids where we do not care to use amalgam and to use gold would be too difficult or require too much gold and time. We must also consider the non- conductivity of the porcelain and that advantage. The reason an inlay does not more often have recurrent decay is because the cavities are usually cut back to sound tooth structure and because the tooth is more tolerant to cement than to any metalic filling.

Secondly : The cavity must not be spoon-shaped, because it would not only be more difficult to set, but would be more apt to fail as it would be held entirely by the cement. It should not be beveled too much for the edges of the porcelain would be too easily broken ; but if slightly beveled the edges will have enough strength and will make a neat joint. With the walls beveled, we again give the cement a great deal to do. In a cavity with the walls parallel, or nearly so, the walls of the tooth will aid the cement in holding it the filling in ; therefore in a simple cavity is best to have the walls of the deeper portion parallel and the margins beveled to get the advantage of the parallel walls to hold the filling, and the beveled edges to diminish the line of cement. Thirdly. The Matrix. Use platinum 1-1,000 of an inch, have it pure, and thoroughly annealed. Anneal it in a furnace or under a blow pipe. If it is only slightly annealed, as you would anneal gold, it will be apt to tear in burnishing it into the cavity. In burnishing use the S. S. White matrix swager with the rubber tip and the matrix plyers with cotton. Gradually tease the platinum to the bottom of the cavity, and do not use a ball furnisher until then. If you can, let your matrix extend enough beyond the cavity to give you an outline of the tooth to go by in building out your filling. Fourthly. The Baking. We select a body which most nearly 40 PROCEEDINGS OF NORTH CAROLINA

matches the tooth in color, mix with alcohol or distilled water, and nearly fill matrix with it and jar to make it settle. After this has been fused, replace the partially filled matrix in the cavity to see that it has not warped, or that the margins have not pulled away from the tooth. If either of these have happened, re-burnish, add body and finish. After you think you have finished the filling, but before you have stripped off the matrix, try it into the cavity again, for it may need a little more body or it may need a little ground away. In either case it will have to be fused again. When the filling is one which requires shading, you can either use different colored bodies and blend them together, or can take a plate tooth which matches in color and break it to pieces, powder these pieces and place them in the matrix in their relative positions with a little body and fuse. As to the refraction of light, it is not necessary to have the filling baked in layers of different colored bodies to break up the rays of light. Three layers of the same body will do this as these layers will have different densities not having been fused the same length of time. If an inlay is fused too long, it will not only lose the good effect of the several layers, but will also lose color, having the yellowish tints gone and a dull, dead, glassy color left. Lastly. The Placing of the Filling. After getting matrix I often dismiss patient for a day or two and bake the filling at leisure moments in the meantime. I then keep the cavity filled with cotton not only to keep out foreign particles, but in ayproxinnal cavities, to widen the separation. When patient returns for filling I always syringe out the cavity and wipe it out with hydrogen per-oxide to oxi- dize any minute organic substances which may not be washed out of the cavity by the syringe. Occasionally a stronger antiseptic is desired, in which case I use 40 per cent formaldehyde, which is not only the most powerful antiseptic known with the exception of fire, but has the advantage over carbolic acid and creosote in that it does not leave an oily coat upon the surface of the cavity which would weaken the hold of the cement. To aid the cement in holding to both the filling and the tooth, get an undercut in the tooth and roughen the back of the filling. Either roughen the back of the filling with a stone, or disk, or etch it with hydrofluoric acid. To get cement of the right color, wet a little, place it in the bottom of the cavity and try the filling in to see the effect. In mixing the cement use either a wooden or an ivory spatular, for a metal spatular often discolors it. When cementing a filling in, carry cement to all parts of the cavity, particularly the margins, also place a little upon the filling. Press the filling tightly into place, keep it dry and keep pressure upon it until the cement is well set to prevent the expansion of the cement raising the filling and leaving rough margins. It is better to have the margins of the filling below the surface of the tooth than above it, for it is better to cut the tooth down to the filling than to cut the filling. It makes no difference how carefully a filling is polished, the surface will not be as smooth as at first, and the surface will catch foreign particles which will resemble the little black specks seen upon low fusing bodies. DENTAL SOCIETY 41

Before letting the filling get wet it is a good idea to protect the cement by covering the filling with varnish or wax. To aid in handling the filling shellac it to some long handled instrument. In cervical cavities, to avoid the gum and to get a more accurate matrix, burnish the cervical edge of the matrix between the gum and the neck of the tooth. In these cavities I believe it best to get an under-cut in the cervical part and have the opposite edge beveled. The cervical margin of the cavity will then help hold the filling in and the opposite beveled edge will make the cement line show the minimum. In approximal cavities extending to the gum and taking in a small part of the cutting edge of the tooth, the fillings can usually be made to stay by cutting the cavities in such directions that pressure upon the fillings will force them deeper into the cavities rather than pull them away from the teeth. When you think it necessary to use one pin, bear in mind the direction of force in biting, shape your cavity so the cervical part of the filling will be held by the tooth and get the matrix. If a platinum wire pin is to be used, remove the matrix and cut a pin-hole a little to the lingual side of the median line of the cavity and as near the cutting edge as you can without weakening the tooth or the filling too much. The pin-hole must be run in such a direction that the filling with the pin can be put in place without bending the pin as this might break the filling. Replace the matrix and mark the position of the pin-hole with a burnisher, force the pin through the matrix into its position in the hole. Now pack the matrix with rather stiff modeling compound, cool and remove it with the matrix and pin. Invest the matrix in plaster and powdered asbestos to hold it in its relative position to the pin, remove the compound and fill the matrix with body in the usual way. Better than the wire pin, is a pin of any desired width cut from 30G. platinum plate. This pin will be soft enough to follow a pin- hole in any direction with little or no danger of breaking the filling. Sometime we may wish to pin a filling in with two pins, and to make it more secure may wish one of these pins to run toward the cervical, the other toward the incisal portion of the tooth. Here shape your cavity, get your matrix, cut your pin-holes in desired directions, and mark their positions upon matrix with a burnisher. Cut your pins from 30 G. platinum plate, and place them through the matrix into their positions in holes. Next fill the matrix with plaster mixed with warm salt water, and after it has set, remove it with matrix and pins. Invest the matrix and pins in plaster and asbestos, remove the plaster from inside of the matrix, fill with body and finish. In removing the matrix from the cavity the pins will pull out almost parellel, but they will easily follow the holes again when the filling is forced into place and will be held securely by the cement. The two diverging pins can be used to advantage in restoring the whole incisal portion of a tooth. The hood crown will be necessary to hold the filling when a considerable portion of the cuttings edge is to be restored especially if it will be subjected to much strain. This was demonstrated by Dr. Alexander last year, and I think was originated by him. 42 PROCEEDINGS OF NORTH CAROLINA

When a cavity is deep we have trouble in swaging the platinum to the bottom of the cavity without tearing it. You can avoid this by partially filling the cavity with cement before getting the matrix, or by getting a cement die to aid you in swaging the matrix. To get this die, mix some cement to a stiff putty-like consistency, and press it into the cavity. To aid in removing the cement, imbed the head of a bur into it before it has crystalized. After the cement has set remove it from the cavity, and roughly shape your matrix over this cement die. You can burnish this roughly made matrix to all parts of the cavity with the danger of tearing greatly diminished. If there is a small tear in the bottom of the matrix that will make no difference, but if the tear extends to the margin you had better make another.

DISCUSSION.

Dr. Watkins: The Doctor has so successfully handled the subject that there is little to be said. Porcelain can be used in the large cavities of the bicuspids and morlars, and I believe the places are unlimited where it can be used. I do not agree with him in regard to the reflection of light, I prefer to have the colors vary. I vary the color slightly as the case demands. If we have the cavity thoroughly prepared and the margins polished we will have very little difficulty, but if the margins have been thinly developed they will break. We should mix our cement powder to the right color. If the cement line has a different color I think we should not be alarmed for a few minutes will see this difference disappear. I like the suggestion about using platinum plate. This porcelain work has come to stay and we ought to give it some attention. There is no unsurmountable difficulty in working it. It requires no more time to work porcelain than any other thing. In time we will become capable workmen. Dr. Crenshaw: I have no doubt but as we shall take up porcelain work and go into it a little bit we will be greatly pleased, and will feel repaid for the effort we make and the time and trouble expended in learning the details of the work. There are a great many difficulties in the way. This porcelain work should be placed where it is most needed. On the labial surfaces of the incisors and cuspids it has a most valuable use. At these points it has been used more successfully than anywhere else. Its greatest and best use is in the cor- ners of the incisors above and below, and on the broken por- tions of the anterior teeth. I am sure it is going to be of great benefit to the profession at large. As I have said, there ars many difncuties in the way, such as the matter of the attachments, the shade of the cement — these are in the prob- :

DENTAL SOCIETY 43 lem and are not yet satisfactorily worked up. If that can be done I am sure we will have made substantial advance. As to the strength of porcelain in comparison with that of amalgam, it has no strength at all. Less than twelve months ago I made a trip to Chicago and Minneapolis with a view to get my own teeth examined and passed on with regard to porcelain. I had first applied to Dr. Alexander to do this work for me. I so disliked the gold, I said if I can get the porcelain I much prefer that. I went to the experts in Chicago and then to Minneapolis. I saw Dr. Peck, one of the most expert porcelain workers. They said as I wanted certain work done that porcelain would not be strong enough. They said it does not stand as well as good gold work. I then decided that not- withstanding the fact that I hated to have my teeth built up with gold, I would have Dr. Alexander treat them, and I would be pleased to have you see what he has done in my mouth. My gums have just gotten' well, and my mouth is more comfortable — I can eat — chew my food much more comfortably than in ten years previously, and in comparison with porcelain I could not have gotten the results. There is another phase of porcelain work that interests us In the large cities — in Chicago for instance, and New York — there are people who have the means to pay for anything of this sort that they want done, and they have it done. But in the country our profession is in advance of our patronage. The further you get away from the large cities the less is porcelain work appreciated. You get away from Chicago and you do not find one-tenth of the people wanting porcelain — they do not want it at any price — they would rather have gold. Though they pay two or three times as much for gold they think they are getting more value. But when you come to charge a man $10 or $15 for a little porcelain work they think it is not worth it — they do not want to make that kind of investment. So this is another difficulty in the way of its use, and how long it is going to be until the general run of our patrons throughout the country and the smaller towns and cities will want it it is hard to say. Still it will pay us as practitioners to spend some of our time in the study of porcelain. In our school we have some attention paid to this porcelain annealing work. Last winter I would go through with them and give them such points as I was able to gather from the experts.

Dr. Everitt : I did not intend to say anything on this subject, but after listening to the paper and to the remarks that have been made I am heartily in accord with many of the 44 PROCEEDINGS OF NORTH CAROLINA points suggested. In my opinion the porcelain has come to stay with us. Take for instance the labial surfaces — I do not think today there is any work we can do that will compare with it. In cases like that of Dr. Crenshaw, where the teeth are broken down, it is not regarded as altogether adequate, but it is the best work we can give our patients. Some valuable points are brought out in the paper. I read it some time ago when he was preparing it, and was very much struck with some of his suggestions there. I have tried some of them and find them very good indeed. I am going to follow them out further and see if I cannot do better than I have so far done. In regard to gold fillings, it is well known among many that we have but one Alexander. He stands as a lone sentinel on the watch tower. I do not think he will receive what I have said as flattery, for he knows I do not mean it as such. But I do say that we have but one Alexander in America or Europe. I have never in my life seen any work done by any one that will compare with his work, and I hope it will be the pleasure of Dr. Crenshaw to allow each member of this Society to look at the work that has been built up in his mouth by Dr. Alexander. It will be a revelation to many. It will be there for ages — it will be what no gold work could do. Dr. Reeves, of Chicago, and Dr. Peck both, do beautiful work. North Carolina has lost, in my opinion, one of the finest operators the State ever had, Dr. Rominger, and his porcelain work compares favorably with theirs. Our friend, Dr. J. D. Whita- ker has also been doing some very beautiful work, and in a short time he will be among the best.

Dr. Gorman : Dr. Whitaker prefers to have the patient go and return after the baking is completed. I think there is danger of injuring the cavity edges by allowing the patient to go away a day or two with these delicate edges of the cavity. Dr. Crenshaw: As to taking impressions: That, you know, is the specific claim of Dr. Peck. I find there is a good deal in the making of the matrix as between the burning and burnishing. When you take the impression and form the matrix from the impression the inside measure of your matrix is the outside measure of the cavity, and the cement, if you observe it closely, makes a difference in the line of demarcation. It displaces practically almost all of the adhering subtsances that we use for holding the cement in place. Dr. Hewitt, of Chicago, claims to have worked out a resinous cement made from dissolving amber, which, when brought down to thinness it must come to when we cement the annealing in place, is practically colorless — about as clear as glass. It is a good DENTAL SOCIETY 45

deal like the cement which spectacle makers use in cementing one lens on another. If you have a porcelain anneal to match the teeth the result will be a cement that casts a shade through the porcelain. Dr. Reeves and others endeavor to combine one color with another until you come to the proper shade. It is possible to have fine results by annealing with one color and top it with another. In this way you can get approximate shades and get beautiful results. In the making of the anneal by the impression system if you make a failure in your annealing it is not necessary to make another impression —you can take the impression and dismiss your patient. In some cases he completes the annealing and gets the work through rapidly, but if the work is at all expensive, he takes the impression, gets the shade of the teeth as near as possible, and dismisses the.patient. When the patient comes back his porcelain is ready. You can put the impression away if you want to, and keep it ten years. If the annealing comes off another must be made, but you do not have to go over taking the impression again. He claims that Brush's cement changes less and answers better than anything he knows of; and that it is not as expensive as some others. He takes soapstone and places that in the cavity before he takes the impression ; and he mixes soapstone with the cement enough to keep it from adhering to the surface of the teeth. Dr. Whitaker: The cement lines are small — they are rarely noticed, but it is necessary to get good cement that will not discolor the whole thing. The body shrinks in baking about one-third. After putting the body into the matrix dry it out a little bit, and then make a cross mark in it. Of course a good gold filling is not as good as a good porcelain filling. Subject passed. Dr. A. H. Fleming read a paper on Abutments and Bands.

ABUTMENTS AND BANDS.

Mr. President, Ladies and Gentlemen of the Society : There is no part of dentistry which can give so much comfort and satisfaction as a well-constructed crown or bridge ; and there is nothing more unpleasant and disagreeable than a poorly chosen and constructed one. The objects of crowns and bridges are service and if beauty ; these two features are carried out, all other necessary requirements are met with. By service is meant the selection of the best crown or bridge, which will in that case give the greatest value in that part of digestion — mastication. By beauty is meant the perfect construction and restoration of the part or parts lost or impaired ; which, of course, means that the device must be artistic 46 PROCEEDINGS OF NORTH CAROLINA and as self-cleansing as skill and science can produce. As nothing is stronger than its weakest point, the first thing is to examine the case carefully and decide what will be the strongest piece of work and then prepare the tooth or root for that work. In preparing a tooth for a crown, the first thing to consider is, what is the condition of the root canals. It is often the case that crowns have to be taken off just because the pulp was putrescent and not treated, vital and not devitalized, or abscessed and not cured. It is generally the case where a shell crown is needed, that the pulp is not in a vital or healthy condition. In cases where there is the least doubt, there should be no hesitancy in devitalizing the pulp, as the tooth is just as good as were it vital. When teeth are abscessed or putrescent, this, of course, must be cured before the abutment is prepared. When these have been treated so that they can be sealed without discomfort, then you can proceed to prepare the tooth for the reception of the band. In cases_of abscessed teeth, the pulp chamber and root canals should be thoroughly cleansed, washed with warm water and then packed with cotton containing creosote. At first this should be packed very loosely in the root canals, so as to avoid pain from sealing gases in the canals. The cotton may be packed tighter at each successive sitting, which should be from one to two days apart. It is a good idea to apply equal parts aconite and iodine, or any counter-irritant, to the gingiva of the affected tooth at each treatment. This applied exactly at the margin of the gingiva, gives the pericementum the best chance to absorb the greatest amount. I have treated several cases of absceessed molars that have also had a puncture just at the bifurcation of the roots. These have been cured and the teeth are used as an abutmnt for bridge work, or have crowns upon them. The best root canal filling I have ever used is made of burnt alum, thymol and iodoform, equal parts, pulverized and worked to a paste with oil of Eucalyptus. This paste is mixed one to two parts of cement, and put in just as though you were filling the canals with cement. Whether this mummifies, pacifies or hypnotizes, it matters but good results_ from its use. not ; but I have never had anything You may drill into a pulp chamber any time after having been filled with this preparation, and you will smell only the odor of the drugs. You may remove a crown from a tooth the root canals and pulp chambers of which were filled with this agent, and you will detect only the odor of thymol, iodoform or Eucalyptus. One case I recall was a lower right first molar which had an abscess in addition to the puncture at the bifurcation. The abscess was cured as before described, and the root canals filled. I then established a fisutla with tinfoil a bur from the outer gum to the bifurcation. I then folded pulp chamber and cut it to conform to the shape of the floor of the and forced this into position with a pellet of cotton. An antiseptic filling was put on this and the broken wall of the tooth was replaced with alloy. The fistula was packed with cotton and iodoform, and allowed to heal from within outward, which it did in about five days. The tooth was crowned and has been doing good service for nearly cases two years. This is, in my opinion, one of the most difficult which we will ever be called upon to crown. The preparation of the tooth for the reception of the band is almost as important as the preparation of the root canals. The DENTAL SOCIETY 47 tooth should be ground down so as to give enough space between itself and its antagonists for a well-filled cusp. It should be ground enough on the mesial and distal surfaces for the proper contour of the band. The tooth should be denuded of enamel and shaped so that the largest part is just under the free margin of the gum. The tooth is then measured with a piece of wire in a dentimeter, and the gold is cut and soldered into a band. This band should be made of 30-guage 22-carat gold, and soldered with 22-carat solder. The 30- guage gold is soft enough to allow easy and best adjustment, and strong enough for almost any practical use. The band is then fitted and in so doing it should extend just under the gum at all points and fit the tooth tightly so as to exclude all food, debris and secretions when properly cemented into position. Just at this point the band is to be contoured so that it will knuckle with the other teeth and conform to the original shape of the tooth. When the patient can close his mouth without touching the band in any position, you may know you have it short enough. The bite is made by putting modeling composition in excess in the band and have the patient bite. Harden this with cold water and remove the band with the composition in position. This is placed on an articulator and as soon as the plaster is hard the case is opened and the cusp is carved. This haying been done the die and counter-die are made and the cusp is swaged in 36-guage 24-carat gold and placed over the composition on the band. The edges are trimmed so as to overlap the edge of the band about one-sixteenth or one-thirty-second of an inch, and then burnished to the band. The band is then removed from the articulator, the composition removed and the cusp slipped into position and tacked all around with 22-carat solder. It is best always to test your articulation or occulsion by putting the crown into position in the mouth, and have the patient bite. The cusp not having been filled, is soft enough to allow the occluding teeth to force the proper articulation, should it not be exactly correct. This having been done, the crown is removed and the cusp is filled with 20-carat solder and finished up. You now have a piece of work that will meet the requirements, properly cemented into position, service and beauty ; and this, when will be as strong and cleanly as the original tooth was.

DISCUSSION.

cor- Dr. Crenshaw : The suggestions made are in the main rect, and I think I would agree with the author as far as I followed the paper. The matter is one of much importance, because it is an operation that must be performed frequently, and needs to be done well. Further than this I do not know that I have anything to say. Dr. Foster: I appreciated the paper, and think it is very well written. I have had some experience along the lines that he has suggested, and I think his paper is all right. Dr. Alexander: I liked the paper very much, and if we follow up every step he has suggested it will be a benefit to all 48 PROCEEDINGS OF NORTH CAROLINA of us — highly satisfactory to ourselves and to our patients.

Dr. Everitt : I think he has covered the ground completely. I do not know how any one can add anything to it unless he has some peculiar way of preparing it that I am not acquainted with. I would be glad to hear from any one who has a different way.

Dr. Betts : We seldom hear a paper read that is so unique in its arrangement and in the discussion of the different topics. I cannot add anything to it except my endorsement. I followed him more closely in some parts of it than in others, and can agree with him as to the method of treatment of root canals. It is necessary when you want foundations of bridge work. I have come in contact with a great deal of bridge work and no structure is stronger than it is. I approve heartily of his paper, and can use only words of commendation for it in its details.

Dr. James : I have never tried his method of treatment of canals, though I have tried a great many things. I have never found anything better than oxy-chloride of zinc.

Dr. W. B. Ramsay : I hope the man who fills them will always have them to remove, and not send the patient to me. I have filled many a root with iodoform and oil of cassia.

Dr. Foster : A good substitute for iodoform is aristol — it is called aseptic.

Dr. A. H. Fleming : If there is any objection to the canal filling, if you wish to deodorize it, use turpentine. This makes a very pleasant smell ; in some cases it is almost like the odor of roses. The difference in filling the root canal with oxide of zinc is in the difficulty of removal. On motion the Society adjourned until 2 o'clock.

Afternoon Session.

The meeting was called to order at 2 o'clock by the Presi- dent. The following applicants for admission were duly elected to membership in the Society: H. R. Parker, O. J. Bender, M. M. Harris, N. T. Holland, J. D. Croom, Jr., R. T. Nichols, and W. H. Edwards. On motion the Secretary was instructed to secure a suitable receptacle for the valuable documents of the Society and to present his bill for the same. DENTAL SOCIETY 49

Dr. L. L. Dameron read a paper on Rubber plates, as follows : RUBBER PLATES.

Next to the preservation of the natural teeth the replacing of them with artificial substitutes is the most important part of our business as dentists, and upon the character of the mechanical work we produce is the estimate that the public places upon us as dentists largely- based. Rubber plates are the means by which artificial dentures are usually retained in the mouth, and in presenting the subject it is not hoped that anything new shall be brought out, but rather that by discussion, and b}r comparing methods, some of us may be benefited, and may be enabled to better perform this important and difficult part of our work as practitioners of dentistry. When a case presents in practice we have first to consider whether it is to be a full or a partial, a temporary or a permanent plate. If a temporary plate is desired, an impression may be taken immediately after extraction, but preferably four to six weeks should intervene between the time of extracting and the time of taking the impression for the plate. I prefer plaster for taking impressions in all cases where it can be conveniently used. An impression tray conforming to the size and shape of the mouth embrace the alve- should be selected ; it should be large enough to olar ridges on each side, leaving a space of one-eighth to one-fourth of an inch between the tray and the external alveolar walls on each side. If a tray of the right size and shape is selected an accurate impression may be taken with a minimum quantity of plaster. An accurate impression is of prime importance, and if we fail in the first attempt to obtain one that is satisfactory, we should repeat the operation until a satisfactory result is achieved. When the impression is taken the tissues of the mouth should be examined, and if parts of the palatine arch are hard and dense, and other parts soft and yielding, the impression should be scraped, or rubbed off with sandpaper, so as to relieve pressure on the hard parts and thus prevent the rocking of the plate. The pressure should be a little more on the alveolar ridges than on the palate, but not more than will admit of perfect contact all over the surface after a few days' wear. It is the opinion of the writer that vacuum cavities are of little or no service, and sometimes positively injurious, and should seldom be employed. quickly, It is desirable that plaster used for impressions should set sodium and this it can be made to do by adding a small quantity of chloride, or mixing with warm water. Patients with sensitive palates are sometimes troubled with nausea to overcome this and retching when impressions are being taken ; some recom- the throat may be gargled with a solution of cocaine ; mend sodium chloride and potassium bromide for this purpose. A dose of potassium bromide administered half an hour before taking the impression is recommended by some. In taking impressions of the upper jaw the heel of the impression tray should be forced up in advance of the anterior part, as that SO PROCEEDINGS OF NORTH CAROLINA forces the excess of plaster out at the front and sides of the mouth. The cheeks and lips should be pressed in so as to copy the external and anterior alveolar walls. Where a partial denture is required, it is preferable to use modelling composition for the impression material, on account of the difficulty in removing plaster from the mouth. When a plaster impression is removed from the mouth it should be covered with a thin coating of shellac varnish and placed in water till thoroughly saturated, then soaped and filled with plaster to form the cast. The shellac forms the line of demarkation between the impression and the cast, and serves as a guide in separating them. The obtaining of the proper occulsion is one of the most important and difficult steps in the process of constructing artificial dentures, especially where full upper and lower plates are necessary, and for this purpose base-plates are required. These are made of wax or modelling compound, and rims of wax high enough to correspond to the length of the teeth are placed on the alveolar borders, and these are marked at the median line, warmed and placed in the mouth, and the patient instructed to close the mouth as if bringing the

molars together first ; this usually causes them to bite naturally. Another method which is sometimes employed to advantage is to direct the patient to place the tip of the tongue well back on the palate and close the mouth. In the effort to draw the tongue back the jaw is drawn back to its normal position. When the bite-plates are tried in the mouth the wax rims may be trimmed away, or built up, as the case may require, until the desired length of bite is obtained. When the bite is judged to be correct, and while the bite-plates remain in position in the mouth they should be fastened together by passing a warm spatula around the wax rims at the point of contact. The whole mass is then removed from the mouth, care being exercised not to break the plates apart, or change their relative positions in removing them, and when removed they should be more securely fastened together by pouring melted wax along the line of contact between them. In case of a single plate the impressions of the opposing teeth are made in the wax rim on the base-plate, and when the cast and base-plate are mounted on the articulator, the impressions of the teeth are filled with water, and plaster is poured in and the cast jarred to make it flow into all the depressions, thus making all the teeth perfect. In selecting the teeth, the age, temperament, contour of face and length of bite are to be considered. Plain teeth have grown very much into favor in recent years, and are used almost exclusively, as they can be better articulated than gum sections. The artificial substitutes should be smaller than the natural organs, as the arch is contracted by absorption, and artificial substitutes as large as the natural teeth appear too large in the mouth. Wax plates are fitted on the models and the teeth arranged on them, and the plate is finished and made smooth just as the rubber plate is designed to be when completed. The molars should not be placed far enough from the median line to cause the line of pressure to fall outside of the alveolar borders, DENTAL SOCIETY 51

as this interferes with the staying of the plate even though the fit be perfect. It is better for the molars and bicuspids to bear the stress of contact, and for the anterior teeth to scarcely touch when the mouth is closed naturally. When the adjustment is judged to be correct the casts are taken from the articulator and flasked. If a gumless denture is made, the dividing line between the sections of the flask should be at the cutting edges of the teeth, but if rubber gums are to be supplied, it should be near the border of the wax plate. Before separating the flask it should be placed in water and heated to about 120 degrees, and it should remain in the water until thoroughly warmed through, and the wax softened so that the teeth will not be pulled out of place when the flask is separated. The wax should be carefully removed, warmed and spread into a sheet about the thickness of dental rubber, and used to guage the quantity of rubber required to fill the space from which it came, allowance being made for fragments of wax around the pins that have to be washed out with hot water. Before packing with rubber the cast should be coated with silex to prevent the rubber from adhering to it, and to give the plate a smooth surface when it comes from the vulcanizer. When the part of the plate covering the anterior gums is made of pink rubber, unsightly spots are often produced by forcing the dark rubber of the plate through the pink of the gums. To avoid this, the pink rubber should be cut into small bits and carefully packed around the teeth, and the part of the mould anterior to the teeth filled with pink rubber. In closing the flask the anterior part should be closed slightly in advance of the posterior, causing any excess of rubber that may be present to escape posteriorly, and not to be forced through the pink rubber in front. The time required for vulcanizing varies according to the prepara- that in most tion of rubber used, and upon the thickness of the plate ; common use requiring a temperature of 320 degrees F. for 55 minutes. About 35 minutes are usually required in raising the temperature from the boiling point to 320 degrees. If the plate is very thick, the heat should not be raised so rapidly, and three-quarters to an hour may be required in bringing it to the desired point. More time and labor are required in finishing a plate when plain teeth are used. The borders may be cut to the desired shape with a coarse file, the plate scraped to the desired thinness, and the surface made smooth with sandpaper. An excavator, from which the point has been broken, or similar instrument, may be ground to a triangular shape and used to scrape the small spaces between the teeth where the ordinary rubber scraper cannot be used. When the surfaces are made smooth with fine sandpaper, a lathe, a polishing cone, pulverized pumice stone and water, will soon produce the desired polish. When the polishing cone and pumice stone have done their work, a little dry plaster rubbed on with the thumb will add much to the polish of the plate. 52 PROCEEDINGS OF NORTH CAROLINA

The tendency to treat this branch of dentistry with indifference and to regard it as of minor importance, and to send the work to laboratories to be done, will tend to lessen the efficiency of the dentist in this line of work. Prophylaxis is important, and the production of perfect fillings, crowns and bridges cannot be too earnestly striven for, but to the patient with an edentulous mouth nothing in dentistry is more important than the proper construction of an artificial denture, and it seems to me that the most important question is how to achieve the highest success in the case in hand. Success is the object aimed at, and its attainment is as important in the one case as in the other, and, as Mr. Emerson well says:

" There is no great, and no small To the soul that maketh all Where it cometh all things are And it cometh everywhere.

DISCUSSION.

Dr. Patterson: Sometime ago someone suggested that I try a rubber plate without an air chamber and see how it would it I quit act, and I did so and was very well pleased with ; so the chamber business entirely. If there is a flaw in it I have not been able to detect it. I heartily agree with the paper. Dr. James: For temporary plates, I think it is better to take the impression immediately rather than wait three or four weeks. Dr. Spurgeon: I enjoyed the paper very much — some is thing points are of very great value to me ; but there one if to take a as to which I differ with him : He says we wish partial impression in a difficult place use wax composition. I think the more difficult the case the more necessity there is for using plaster. Take the plaster out when it is just hard the pieces together enough, but not too hard ; if it breaks put and it makes a correct impression. percha. It : I have used vulcanized gutta Dr. Wheeler _ takes a little longer, but produces a much more artistic finish. The only question in my mind is whether or not the vulcanized gutta percha will stand the action of the salivary fluids as well as the rubber itself — I do not know about that. I saw a recorded statement of some gentleman in the South who had rub- used it ten years and that the wear was equal to that of ber. The use of wax I dislike more than anything else. If it is is a little too hot it runs over the hands. Gutta percha cleaner and produces a much more artistic effect in the finishing, though, as I say, it takes a little longer. to is said in Dr. Dameron : I have nothing to add what :

DENTAL SOCIETY S3

the paper. I think this matter of taking impressions, where the teeth are set in different directions — where you could not remove the impression from the mouth, you could not get the plate into it. I think in cases like that it is a matter of individual choice ; some prefer the model composition, and some the plaster. I have had some little experience with plaster in that way, and I do not care to have any more of it. Dr. W. M. Robey read a paper on Dental Education

DENTAL EDUCATION.

In beginning this short discourse on education the thought comes to me that possibly you may as I go along, question the wisdom of the committee that placed me before you today. This same question has serious weight with me, but, inasmuch as sometimes a horrible example has such a stimulating effect, we hope that such carelessness will never be repeated. The stage of stasis is to be avoided. Let a man hate me or love me, but never be indifferent. Avoid lukewarm- ness, give us either extreme, but never the happy medium. But the testimony of the laity is of value even to the greatest scientist. So also do I hope that this testimony will be of some value to this body. The power of example is of inestimable value in this universe. The polish, the finish, the grace of the educated inspire the uneducated to ambitious achievement. It is true that the ignorant often mistake the mountain in the distance for a hillock nearby, and perish over the precipice in attempting to reach it without following the narrow crooked path step by step. These pitiable attempts of the unwary serve as examples, words of warning to those higher on the ladder, of the uselessness of attempt without regard to detail. Short cuts to true education are impossible. As well try to build a mountain without sides. Only by laying the proper foundation stones, truly and

accurately ; broader at the base, narrowing as we near the top can we get full advantage of education. The foundation stones of our profession are the different branches of our academic education. The broader and firmer the foundation the surer the future edifice. One of the chief advantages the dentist of today has over him of the past, is the systematic course of study afforded in our dental schools. Another is the means of record and comparison in our dental journals. The practitioner years ago studied until he thought himself capable to undertake the work of his profession. I lay stress on the pronoun, for I am sure the younger members especially, can recall the side talks of dissatisfaction upon the absurdity of rule that

curtailed the privileges of the freshmen in the infirmary ; the absurdity of so much theory, anyhow. And yet how few of us were willing to be the subject for the first year man to make his debut upon. Our predecessors were sole judges, as to fitness, made their own rules, mapped their own courses, and followed them according to their own wishes. Their advantages as to system were limited. Mechanical training was a great deal less developed than at present and theory was almost unheard of. The trade of dentistry was to be brought up to a profession. Lessons from experience were more or less tradi- tional, and men rode hobbies just as they do now. The systems were 54 PROCEEDINGS OF NORTH CAROLINA

almost as numerous as there were dentists. The fathers of dentistry were great men or they could never have lifted their work from chaos to order, from a mercenary trade to a true profession. Now while we have many systems, each of these is under the control of many heads. One mind with all its ruts and hobbies does not govern any system. But many systems, with their inconsistencies greatly eliminated, are brought together under one organization. Is it any wonder after the organization of societies and institutions for promoting dental learning, the completion of a more systematic course of learning, with the profession at large to make suggestions, instead of one or two individuals, that we advance step by step, that we are doing more than our brothers of years ago ? But

the questions come : Who is doing this work ? What heads are looking after this great system ? Is it the profession at large, or is it a few individuals ? It is useless for me to say that the profession proves the work as it is done, uses the good and throws the chaff aside. We know how to appreciate a good thing, and we use it to the best advantage, but what do we give in return ? Dollars and cents, of course, but very little real work. You answer that it is not expected that every one delve into theory and science — let those specially prepared look to that — we have our practices to look after — we are not all fitted for it. These are exactly what I am driving at. We leave this to the individual, even when we know that the work of a single individual can only be a drop in the bucket, even in the course of a life-time. In our practice we are too selfish to make original research. We are not fitted for our work. For it is our work, for every man of us owes to his profession something. The student before entering into a profession should be not only capable of mastering it as it is, but of adding to it by work. His fundamental knowledge should be such that he can have a correct under- standing of what he is doing. He must be able to do for himself, and this can only be accomplished when he possesses the proper fundamental training. It is very hard for a few to bear the brunt of battle and the camp followers to get the spoils. It is very hard for the state examining boards to be the lifters, helping the profession up, when the men who come before them should know how to climb, license here, It is very cruel for the boards to prevent one of us with fault is it is it the schools ? to practice in a sister state. But whose ; profession Yes, partially. Is it the student ? Yes, partially. And the has her part of the blame to bear. Some of our schools do not require the standard they should for entrance. They say we have the same requirements that our colleges very do. In their catalogues that is very true. But they run much they like politics. If they need him they need him, and if they don't, spelled don't. And they usually need him, even if his name is badly when he registers. idea ot Now before I close I wish to say this in regard to my our dental society. Its sole object is not to get together a body of ethical dentists to discuss ethics and regulate fees. Neither is it solely for social purposes. My idea of the society is that its primary simply for us use is as an intitution for higher dental education. Not take the to take, and give nothing in return. Not to come here to good things of others that are more generous, and then go off home for and eat our own good things without offering to divide. But DENTAL SOCIETY 55 each of us to come here with the determination of giving anything we have, and having something to give. Until we are nearer the ideal we cannot all do this every time. But there are few who cannot contribute his mite now and then. It may be that the young men just entering our ranks may think some things they hear and see very dull and hackneyed, and they may seem dull to the student who has had them thrown at him in the class room for three or four years. But let me say this much, he will have more respect after practicing a year or two. And as a last plea let me urge upon every young man who is entering these ranks the importance of joining this great institution for higher dental education. He is needed and it is necessary.

DISCUSSION.

Dr. Ware : I enjoyed the paper very much, and it has many good points which we should consider. The standard of entrance to our dental colleges is higher now than it once was, but I do not believe it is high enough yet. I believe every person should have a good literary education — a good literary foundation. I do not say he should be a college graduate, but he should have a good practical high school education before attempting to enter the noble profession of dentistry. I do not think the dental college should accept him unless he can furnish a certificate of graduation from a graded school or from a high school. All honor to those men who are prominent in our profession who did not have these literary advantages ; all honor to them for their success and the good they have done us, the noble example they have set us, and the great things they have accomplished. Many times it seems they have out- stripped those who have a good literary education, but who can say that they would not have succeeded still better if they had had this education? No one of us would hesitate to think that they would have done better. I believe the standard of entrance in our dental schools should be gradually raised. It is deplorable how many young men without any adequate literary foundation attempt to enter the dental profession. And in many cases they enter the profession of law, or of medicine, or of teaching. And who is responsible for all this? We ought to elevate our profession. Let it get on that high plane on which it should stand, but it will never do it while we encourage young men to enter without sufficient preparation. Dentistry, like other professions, may be divided into several different branches. You may not have special mechanical skill for building bridges, making plates, etc., yet if you have common sense you can learn to put in a good filling, and to treat pyorrhea. I long to see the day come when we shill see these different specialties developed. The profession of den- 56 PROCEEDINGS OF NORTH CAROLINA tistry is a broad profession. We should encourage young men who wish to enter this profession to acquire a good literary education. How much one who has studied Latin and Greek and French — how much advantage he has over one who has not opened a text book of that kind. He can look over the technical phrases and understand them without referring to his dictionary. He can understand them as soon as he sees them. He knows the right meaning of these words at once. So it is important that they have this literary foundation to start on. A dentist ought not to sit down and shut himself out from the world ; he ought to be a leader in his community. Why shut himself up in his office and not be known outside of a litte dental work? Den- tistry is one of the best professions a man can engage in. How close this profession is to our Divine Creator. How we should train and cultivate our minds and try to be as near to God our Creator as we can because we have to repair and restore what nature has lost. We cannot study too hard to be able to obtain and restore these lost parts. I believe a dentist ought not to shut himself up in his office and seclude himself from the outside world. He should be in demand outside of dentistry. And yet he will do it if that is all he knows, unless he has studied these other things in college or somewhere. The dentist is too much inclined to do that. In variety of reading and study there is rest. I think we ought to give this subject more study, more thought, and see if we cannot induce young men to enter this profession, this noble, high, grand profession of dentistry, with a good literary foundation.

Dr. Livermon : This is one of the best papers I have heard read before this Society. I believe if the suggestions are carried out by the practitioner we will soon put our profession on a higher plane, and put it on the basis of a profession and not a trade, as some of the other professions speak of it. It is a sad fact that many of us have not had a literary foundation laid deep and broad, which would have made us better dentists, and of more honor to the profession, and made us more help- ful to suffering humanity. I would not say one word against any young man — I would not throw a straw in his path that would cause him to turn aside because he has not this foundation well laid, but let him remember that while he may not have this broad literary foundation before he enters the profession that after all it is not too late for him to learn. We can recollect some men who, when they began, possibly did not know anything as they should have known it, but yet rose and have received the greatest honors given to any people from DENTAL SOCIETY 57 any land. I believe one of the Presidents of the United States hardly knew his letters when he was a married man.

Dr. Harper : I have spoken on several occasions on this subject before this Society, and it is ever my privilege to stand in defense of that which elevates dentistry. I know of nothing that can place the profession before the public more advan- tageously — make it attain to the position we ought to occupy — than a better education. One of the disadvantages in which we are placed is manifest in this one thing. Just why this should have been I do not know, but there are a great many people who seem to think that it matters not what a physician says or does — it is all right. He may make a mistake and bury his patient and that is the end of it. Our mistakes are not buried, but live to warn us and others. Take a physician with a limited education and he may have a good practice but he cannot attain to that eminence in his profession to which he would attain if he had a broad, liberal education. I like to see a young man, when he enters this Society, be able to prepare and read before the Society a paper that car- ries conviction to every one of us that there is a trained mind. We may expect that "the profession is going to be benefited by such a man coming into it. The idea is abroad that a man can enter this profession without any preparation — that this profession don't mean anything. If a young man says, "I will go to school and come back in a short time ready to open an office," it is an honor for every one of us to approach him with candor and honesty and say to him, " Young man, I will be your friend if you will allow me." There is room in the profession — it is not overcrowded — but the old idea, often expressed, that there is room at the top, will never touch the uneducated man, because it takes an education to climb that ladder. There are many young men who want to enter the profession, but they should be encouraged to acquire a good education first. Education broadens a man, and helps him to grasp that which is an honor to the profession. If there is anything which ought to be near to our hearts it is the uplifting of the profession with which we have identified ourselves, and to which we have given the best there is in us. I may not live to see it, but I want to live to see our students stand side by side with medical students and those of any other profession. Then, and not till then, will the broad principles underlying the profession be understood and known by the people to whom we give our best efforts. We ought to encourage young men that the greater their education and development, the more easily they can reach up to the better class of 58 PROCEEDINGS OF NORTH CAROLINA

people, and will hold their practice when they get it. When a man knows that he stands on a level with other men he will not shrink from the responsibilties that may be laid upon him. It is only the educated men that can attain to this standard. When a young man wants to enter the profession and is not educated let us not only encourage him, but let us furnish the money, if necessary, to help him — if he cannot get it otherwise, furnish the money to help him educate himself. When he is educated he will devote his life to the profession and will honor those who helped him in his struggle.

Dr. James : I believe these gentlemen are underrating our profession. I do not mean to reflect upon any profession, but I do say that other professions have as many ignorant men as we have. Times are changing. We have as good a class of people in this Society as can be found anywhere.

Dr. Everitt : There are men in every profession, legal, medical, and what not, who, when they get their diploma or license, do not amount to much, they drift around from one point to another. It is so in all professions — they have no ambition to get any higher than the lower rung of the ladder. They do not expect rise to in their profession ; all they want is to make a living, but you take a true gentleman, a young or a middle-aged man who appreciates his license, and who is ambitious, whether he has a high school or college education, if he is determined to succeed he is going to hold himself up, and will make the people believe there is something in him. You cannot down him ; you cannot make him sulk, or hang around in any way whatever. He is continually getting on, and it is the duty of every one of us to push that man forward and help him up the ladder until he gets to the top, and you will make a man of him before he stops. The man who enters this profession just to make a living, who is satisfied with that and has no ambition to get any higher, will always be a drag in the profession. It pleases me greatly to look at this fine body of men. I remember how this Society looked thirty years ago when it was organized over in Beau- fort. I have looked at it from one year to another and have seen the progress that has been made. It is a different class of men we have today ; men who are proud, ambitious and who exert a marked ethical influence. It is a pride to me to take them by the hand and help them move forward. Take the class of men we have in the profession today and they will measure up with those of any other profession on earth. I care not where they come from. DENTAL SOCIETY 59

I heard this Dr. Spurgeon : For about twenty years have subject discussed. I have heard different representatives from the colleges discuss it, and it is still a proper question, to know how to increase our own reputation in the estimation of the public. I believe that our own profession is more responsible for the estimation in which we are held by the public than any other one thing. In the medical profession, I do not care how many mistakes they make, you cannot find another physician that will say, " He has not done the proper thing." But in our profession, if one does something that is not exactly as another would do it we are too apt to say that it is folly — he has done a wrong thing. As long as we criticise each other we will never be recognized and held in esteem by the people. If you see that a mistake has been made, keep your mouth shut. will criticise what his Dr. Everitt : No ethical gentleman professional brother has done. But if a mistake has been " made, and one is forced to express himself he may say, He did the best he could." But no gentleman will come out and say his professional brother has done a bad thing. gentlemen Dr. Alexander : The remarks of the last three in regard to the dental profession are strictly in accord with a profession my views. It is up to us as to how we stand as ; it is not up to the medical profession how we stand — we do not look up to any physician to give us his opinion. As a dentist I look to the older men in dentistry who know more about it than I do, and who have the respect of the people. If the educated men of our profession, and all of us together combine to hold the profession up to the proper plane, we will not have to compare it with any other profession. Let us stand right on what we are — be right on the platform of dentistry — modern dentistry — conscientious dentistry — Chris- tian dentistry — and then we need to have no man's endorsement. Others will look up to us. When we practcie dentistry as we see physicians practice medicine, we will not have to look up to them. The dental student is one who does not look up to any man except to men in his profession who knows more about it than he does. I am going to have as much respect for the men of other professions as any man can have, but I am not going to compare myself with one of another profession and put myself a little lower than he. He must measure up to me — I am not going to measure up to him. been said, but Dr. Ware : I heartily endorse all that has I fear that I was misunderstood in my position. I did not say that because a man prepares himself for some other profession 60 PROCEEDINGS OF NORTH CAROLINA that he would take up medicine, but that that impression is abroad. I have heard it and realized it to a certain extent. I believe our profession is just as important as that of medicine, and I would like to say, as broad. I think we should do more to stand upon our own platform, and we ought to have the respect of people around us, of the medical and of all other professions.

Dr. Everitt : I am glad to say that the education and standing of the dental profession has made very rapid progress for a number of years, and now we are in good standing with all other professions. I have no doubt that that is true in many towns today. It is so in Raleigh — our physicians there do not hesitate to call upon members of our profession for con- sultation. They are very largely governed by what the dentists may say in regard to matters pertaining to the mouth. I have known of several cases there during the last few years when the physicians were in doubt as to the proper thing to do and called upon members of our profession for consulta- tion, and they have adopted their treatment and carried it out and the patients have recovered. And it is so in all other towns, I think. They are ready to admit that the dental profession is better prepared to treat diseased mouths than medical men, and they co-operate with us very largely, and I am glad to see it. I believe that in a short time we shall be fully recognized at all points.

Dr. Foster : I am particularly interested in this question, and for the edification of some I may say something about the recent session of College Faculties in Washington, D. C. Touching the point raised by Dr. Ware as to certain literary qualifications being credited on certain time in the dental college curriculum, as you know, some effort was made to reduce the course in dentistry back to three years ; but it stands at four years. Some dental colleges have tried to meet this difficulty, and if a person has completed a certain amount of work they would give him credit for so much time, but not for more than one year. The College Association adopted the system of grades. A man is graded upon what he has actually acquired — so many counts on such and such a subject. The requirements after entering have been placed on the graded system also. The college faculties have indicated a number of subjects upon which the applicant should pass examination. These examinations are to be verified by the State Superintend- ents of Education, as was our previous custom. I do not blame the colleges for taking students not pri- marily qualified — we do, and I think we take them with as DENTAL SOCIETY 61

high a standard as the rest of them. Some are taken who have spent only one year, or two years, or three years in a high school. If any of you gentlemen have studied in our high schools you have found that the third year is a hard one. One who has completed the high school course with credit to himself has as much right to enter a dental college as one who has a college diploma. I think it is best to allow some, credits for literary qualifications on the fourth year course, but I believe it is best for dental colleges to teach certain subjects, to introduce into their course — say the fourth year — some course along the line of literary qualification. If the colleges would add to their curriculum a course in English, mathematics, philosophy or language, we would do more than we now do in teaching dentistry. Why do I say language? Because students frequently do not understand what we are trying to teach them. Why do I say mathematics? Because mathematics underlie all business matters — no question about that. Noth- ing teaches us to reason more systematically than mathematics. Why do I say philosophy? Because it teaches men how to live — teaches them the principles of things. If we could teach them philosophy we would not need to have so many papers on dental ethics and dental jurisprudence, that are, sometimes, somewhat wearisome. I suggest these things to this body because the dentists of various State associations have done more to build up a higher dental education than any of the collges ever have.

Dr. Robey : My idea of education is that it is to be done a little at a time, even if it takes twenty years, and then twenty- years after that. The recognition of the medical profession has been discussed and I agree with all that has been said. The chief idea of the paper is that we must become more technical, more scientific than we are, in order to raise our profession to what it should be. Dr. F. S. Harris read a paper on "Some Forms of Crystal

Gold, Their Range and Limits," as follows :

SOME FORMS OF CRYSTAL GOLD, THEIR RANGE AND LIMITATIONS.

It has occurred to me that something on this subject might be of interest — and more than that — of real practical value to some, at least, in this assembly. Because a material or a method has been in vogue for a long time does not argue that the subject need not be reviewed. Like the sheen of some fabrics, each time it is held up to view it may catch a different light and yet its beauty or intrinsic worth 62 PROCEEDINGS OF NORTH CAROLINA

not be marred nor essentially changed. Pure gold is essentially the same, wherever it may be found, yet it must be separated from its baser associations and refined and differentiated to suit the varied needs in arts and manufacture. My associate, Dr. C. A. Bland, will subimt a paper on the use of cohesive gold but he will not specifically differentiate as to forms and methods to be employed. I have chosen to say something about crystal gold: Firstly, because of its valuable features, and secondly, because I have never heard much said about it. Practitioners, generally speaking, have not been impressed with its value, or they have not said so. My experience with it dates over a period of fifteen or twenty years and justifies me in declaring decidedly in its favor. Let it be understood that I do not limit the term but embrace under this head, sponge, mat, crystalloid, felt, etc. It may be of interest to some of you to hear a brief review of the introduction of crystal gold to the dental profession as a material for filling teeth. The S. S. White Dental Manufacturing Company kindly made excerpts from dental magazines and literature in their possession which enables me to present a short statement of its early use and which credits A. J. Watts, of New York, with its first introduction in America, while about the same time it was brought out by a Mr. Barling, a jeweler in England, and there received the early notice and endorsement of Mr. John Tomes. Permit me to read a

few extracts : "Crystalized sponge gold. Alfred J. Watts' original patent. Dated April 26th, 1853. " To enable others skilled in the art to make and use my invention, I will proceed to describe the process by which the gold is prepared. " I take gold, either pure or alloyed, dissolve it in nitro-muriatic acid as usual, and precipitate by protosulphate of iron. I wash the precipitated gold with diluted hydro-chloric acid, to remove any peroxide of iron, or other impurities, edulcorate with hot water and dry it thoroughly. " I now amalgamate it with from four to twelve times its own weight of mercury, triturate it thoroughly and then set it to one side, and allow it to stand from one hour to twenty-four hours, according to circumstances. " If I wish the gold to be in a highly crystalline condition, I make a pretty fluid amalgam and after thorough tritmation put it in a flat-bottomed vessel and heat it gradually till it is quite hot and pain- ful to the touch, say from 180 degrees to 240 degrees F. I keep it at this heat for a few minutes and then, allowing it to cool gradually, let it remain some hours as before said to condition itself. I then pour over it pure nitric acid diluted with about its own bulk of water. I apply heat, very gently at first, and as the action progresses I increase it. Towards the end of the operation, when the mercury appears to be all dissolved out and the gold presents the appearance of a mass of crystals or semi-crystals, sponge, etc., I pour off the acid solution of mercury and pour pure undiluted nitric acid into the vessel containing the gold and apply heat. This dissolves out entirely "

DENTAL SOCIETY 63 the mercur}'-, or any other metals which may have escaped the action of the diluted acid and also any of the salts of mercury remaining in the pores of the gold. " After washing with hot water and drying, the gold is left in perfectly pure condition. But, in this present state, it is very pliable, non- cohesive and so easily broken down that it will not bear the slightest handling without breaking up into a fine powder and must be very tenderly treated while getting in a position to be subjected to the next process. cherry-red, "When this is thoroughly dry, I raise the heat to a or to a heat just short of the melting point of gold. This is a particular part of the process and requires care and skill. The heat must be raised just to that point which will partially liquify without actually melting the gold, and when properly managed, the gold will be left of in the condition of a soft malleable and extremely ductile mass crystals, radiating from centres and crossing each other in every direction and will bear handling without crumbling to pieces, and upon pressure will readily weld into a solid mass, eminently fitting it for the purpose set forth. * * *

Here is a portion of a letter from Mr. Tomes to Editor American

Journal of Dental Science : " 37 Cavendish Square, London, Aug. 8, 1853. " I wrote to you, * * * and Dear Sir : Some months since enclosed a specimen of the sponge gold, prepared here. Since that time, the party who made the preparation has been actively engaged in its improvement. A few days since he sent me a bottle of spong? gold far superior to anything I had seen before. Tt is kept in naptha and this is ignited and burnt off when you want to use the gold. Treated in this manner it is most extraordinarily adhesive, and readily works up into a solid plug; bit by bit is added, the_ fresh morsels readily uniting with that which has been compressed, it being necessary only to keep the surface dry and a little rough. I find it best to press the gold into the cavity with a tolerably large instrument and then to use a pointed one of course. Burnishing in the progress of the filling is to be avoided. After completing the plugging and filling, the burnishing requires to be done with a light hand, otherwise from the peculiar condition of the gold the instrument becomes coated with the metal and scratches instead of polishing. I feel greatly interested in the ultimate result of the experiment, because I think the preparation intrinsically good and because I trust the maker may be remunerated for his labor and expenses. I give you his Kent, Eng- address : Mr. Barling, Jeweller, High Street, Maidstone, land. Yours faithfully, "JOHN TOMES."

Dr. W. H. Dwindle, in a paper in the American Journal of Dental Science for April, 1854, speaks of the needs of the profession for a plastic gold, so conditioned that it may be consolidated into a mass, and so perfect as to answer all the tests that could be applied to melted gold. He then alludes to sponge golds produced by the pro- cesses described in the preceding excerpt from the Journal for Octo-

ber, 1853. He further says : 64 PROCEEDINGS OF NORTH CAROLINA

" While in Europe a little more than a year ago, Mr. John Tomes, surgeon dentist to Middlesex Hospital, London, showed us an article of sponge gold uniting more desirable qualities than we had hitherto any knowledge of. It occurred in irregular rounded masses or pellets, a little larger than an ordinary sized pea. Its surface was of lighter hue than its appearance within, glistening at different points, as though since its formation it had been subject to a high degree of heat, yet without diminishing its softness or pliability. On breaking it open its peculiar spongy character manifested itself in a most beautiful degree, its infinitesimal particles uniting together, forming a dense and delicate net-work. We filled two or three extracted teeth with it, forming exceedingly hard stoppings. After polishing these, with a graver, we engraved lines and letters upon them, which on being subjected to a powerful lens, displayed the angles of each groove as clean and sharp as though it had been cut upon jew- * * 6 p 1 f"\r T At the same time and without any knowledge of the experiments or success of Mr. Barling, Dr. A. J. Watts, chemist, of Utica, New York, was pursuing a series of chemical experiments with reference to obtaining an article of sponge gold which should supply the wants of our profession, and shortly after our return, he placed in our hands three different articles of sponge or minutely divided gold." Then follows a description of these forms — the first of which and its method of preparation have been described in this paper. Dr. " Dwindle continues : With this last article we have had considerable experience and with uniform satisfaction, especially in large stoppings. " In using the sponge gold we adopt the following method : With a sharp blade we cut off from the cake of gold a sufficient quantity for our present purpose ; this we anneal thoroughly with an alcohol lamp, and then, spreading it upon a clean piece of paper before us, we cut it up into fragments and pellets best adapted to the cavity into which it is to be introduced. " Being previously provided with various instruments whose extremities are subdivided into two or more points, we, by pressure upon the sponge, readily induce it to adhere to them, when we carefully carry it to its destination in the cavity of the tooth, which has been previously dried with paper. As the operation is repeated, accompanied with thorough packing and pressure, it will be found that the particles of gold readily weld together into a solid mass ; so that when the stopping is completed it, in all respects, resembles melted gold, and may be subjected to the same treatment with impun- ity- " For the purpose of determining its various qualities as a stopping for the teeth, we subjected it to the following tests : "To test its malleability, we took a large plug of gold formed in the manner just described, laid it upon an anvil and with a hammer beat it to flatness ; annealing it, we passed it through a rolling mill when it was formed into plate, as perfect in all its characteristics as any plate made of pure gold. " To test its ductility, we took a similar plug, formed as before, and drew it out into wire as fine as No. 8 Stubbs' plate. " To test its corking or stopping quality, and the impermeability of its antagonizing joints to fluids, we took a piece of thick glass tube, DENTAL SOCIETY 65

about a foot long, into one end of this, to the depth of more than half an inch, we introduced a stopping of sponge gold. Inverting the tube we poured into it a solution of red saunders ; we then closely fitted a piston and rod to the tube immediately above the fluid, and upon this applied a weight. At the expiration of 24 hours, the fluid had not made the slightest progress downward. " To test its ability to being built up into irregular and independ- ent shapes, we have, repeatedly, reproduced from one-half to three- fourths of the entire crowns of molar teeth in gold. " As a further test we took a block of ivory, chucked it upon our lathe, and with small tools formed a matrix to correspond to the size of a large finger ring. Into this we introduced by packing and con- densing, as in stopping teeth, more than five dwts. of sponge gold ; placing it back upon our lathe, we turned out the ivory within and without the golden circle, until it became entirely separated ; this readily endured, all the necessary process of filing, stoning and burnishing into a beautiful massive gold ring, which has been worn constantly for several months and will, in all respects, stand trial with any pure gold ring made in the ordinary way. It has this advantage, however, over all rings made heretofore ; it is a ring, an uninter- rupted ring, and ' has no end ;' a continuous circle with no alloy between ! "As a test of density, well formed plugs do not shrink under the blow-pipe ; their inner surfaces are bright and solid, while their polished disks take the graver like plate. " Under the microscope it presents a beautiful and gorgeous appearance, like looking into a golden sylvan groove, each moss> arborescent branch being in the form of a six-sided crystal. " Although we consider Dr. Watts' sponge gold indispensable to our practice, yet we do no think it will ever entirely supercede the use of gold foil. It can often be used to great advantage in combination with gold foil. In large stoppings it possesses great advantages over foil from the facility with which it can be introduced and consequent freedom from fatigue which ever accompanies long operating. " We think no one in our profession who has had experience in its use would be willing to be without it. " Dr. Watts is deserving of great praise for his persevering course of experiments which have resulted so favorably to our art. May he reap the abundant reward he deserves." It is needless for me to state that in late years these forms of gold have been vastly improved so that they are eminently adapted to a wide range of cases and are fullfiling the prophecies of its most ardent early advocates, some of which I have quoted.

To some of these cases I will address myself : First. It is especially applicable to all cases which do not involve a considerable portion of grinding surface or of cutting edge. For these we think the heavier foils are par excellence, inasmuch as they may be laid down in regular laminae and are capable of being condensed to a more steel-like finish which will the better resist the force of mastication. Secondly. It is more applicable to distal or posterior cavities towards the back of the mouth because of its better adaptation to starting. 66 PROCEEDINGS OF NORTH CAROLINA

Thirdly. Teeth with frailer walls may be more successfully treated than with most forms of foil. Fourthly. It is usually more pleasant to the patient and saves great nerve strain on account of the facility with which it may be packed entirely with hand pressure. This obtains to a greater degree with these preparations than with any method of preparation of foils with which I am acquainted. Fifthly. There is a saving of time and labor in almost all cases, within the range indicated. These excellencies will not be manifest to the careless user of these forms of gold who bcause, forsooth thinking he has a soft thing he can stuff a cavity with it in short order. There is no material, noble or base, that will be successful in such hands. Respect must be had to its individualities and peculiarities and as the eminent artist mixed his colors with brains, so we must use the materials we employ. Crystal gold is no " royal succeedaneum," though it was early supposed that it would take the place of these in many cases where amalgam had been employed because the foils and methods of that day were not applicable to them. I have used, in my practice, Sibley's Felt, Crystal Mat, Williams' Crystalloid, Watts' Crystal and Moss Fibre. With all of these I have had very similar results and I believe either of them is capable of filling the range I have previously indicated. However, I have found myself more generally using Moss Fibre and there is an advantage in sticking to one thing long enough to be really familiar with it and to better bring out its excellence. At the risk of being tedious to some, I will say something about methods of use. In the first place it is essential that the material be fresh and that it shall not have been bruised or in any wise previously condensed. To this end it should not be removed from the box but should be carefully uncovered so that a piece may be torn away from the edge of the mat with instruments having delicate points. A smaller portion of this mass may be placed to one side on the pad and torn to suitable-sized pieces for beginning the filling and the larger portion may be picked up lightly with pliers, placed upon a sheet of mica and passed carefully over the alcohol flame for the purpose of driving away any gases which may have been deposited from the atmosphere. As with other cohesive golds this heating renders " " it softer per se and at the same time more susceptible of being made harder under proper condensation. The cavity preparation is not essentially different from that for cohesive foils generally, but it will be found that a start is more readily obtained by reason of the fibrous nature of the gold. The pieces must not be so large as to have to be squeezed through the opening in introducing the gold and should be carried carefully accurately to the point at which it is to be sealed and placed there with a light pat successively over the whole surface of the gold with an instrument as large as may be conveniently used and followed by smaller points as may be needed, to thorough condensation. After the filling shall have been well started begin the use of the annealed gold and build out carefully to a finish. Special care should be taken as the margins are approached not to use too large pieces, else there may be an overlap before the margins are really filled and sup- DENTAL SOCIETY 67

ported. For the sake of a fine finish let the last layers be particularly- well worked over with fine and clean points. Hard pressure all the way through is used and advocated by the writer but not of the lazy or finniking kind. It must be thoroughly well done and the force exerted on a line with the axis of the tooth as nearly as may be, which is. in no wise different from the principle that obtains in all filling operations. The instruments sold by dealers for working the mat golds are well adapted, in the main, for the purpose, but such an endless variety is not necessary to any one person in this or in any other method of operating. In general they should have regular smooth and shallow serrations and should ordinarily have the slightly oval face and from that to nearly round and side serrated up the ; but, in some cases, notably in securing pieces in retaining points, they may be of perfectly level face. Some of the modified ball forms are very useful in restorations along the palatal wall of the incisor teeth. I will take pleasure in showing to any who may desire it the forms I have found most useful. In conclusion, it is needless for me to remark that the subject is much bigger than the paper, but I trust I may call the attention of some to the importance of investigating a material that possesses so much merit to the end that its excellencies may be better set forth and its weaknesses — if it has them — pointed out.

DISCUSSION.

Dr. Bland : The history of the manufacture of crystal gold was of peculiar interest to me. We find other materials of which we have no knowledge as to how they were obtained. It is important to study the history and method of procuring these things. It was specially interesting to me that the practitioner of fifty years ago could tell what we would do today — men who had such thorough knowledge of the profession that they coud look forward into the future and tell things to come. In regard to avoiding the nervous strain of the patient, that is something that is taken into consideration very little. We do not consider this as much as we do to accomplish a definite object. We do not study the health or the nervous system of the patient. I believe we shoud guard against working on the nerves of a patient so as to upset him for a month afterward. This has been done by long and tedious operations. You can use this moss gold if you build up against delicate walls. Place it carefully over the bottom, build on that, and after covering you can go ahead. My experience with it is limited, but I can very readily see the advantages.

Dr. Carr : The subject before us now is one in which I have been interested a good many years. In 1875 I first began the use of Watt's crystal gold — nearly thirty years ago — and 68 PROCEEDINGS OF NORTH CAROLINA

I endorse all that has been said. Every day I have had it in my office. The history of the manufacture of Watts' crystal gold is very interesting indeed. I was his guest in 1880, in Brooklyn, and he showed me the whole process. He told me it is according to the formula how it was made, ; but now made described by Dr. Harris. The operation up to the time of his death, after going through the treatment with quicksilver, was to purify the gold as well as he could by heating and burning out the dross and dissolving the refuse gold in aquia regia. It was deposited from time to time by a current of electricity passing through it. Under the microscope it was beautiful. It looked just like feathery leaves, and I have in my office some of these specimens that he gave me. My recollections gentle- of Dr. Watts are most pleasing ; he was an amiable man, thoroughly enthusiastic in his work, and has done a great deal for dentistry in putting that gold into our hands, and I have been surprised to know how few men today avail them- " selves of that gold. As Dr. Harris says, if its use is well learned, it is the finest thing in the world." Start with any form of moss fiber or sponge gold, it is the best thing in the world to start fillings with, then finish with heavy rolled gold if you want to. It is not so trying on the nerves of the patient, and it is so easy to use that you can take a large piece of it with your hand instrument and pack it in. But you must be more particular with moss gold because of the nature of the gold. Put in a good sized pellet of it and crowd it down with an ordinary point as with soft gold. If you press it too hard at first you are liable to make it into a little ball of but if you gold, and it will be dense only at certain points ; press it at first carefully, then a little harder and harder, you can work it as you work wax. pleasure. I saw Dr. Everitt : I heard this paper with great some specimens of Watts' crystal gold that were simply marvelous. I saw some work he had done twenty-five years can take an engrav- before that. It is perfectly beautiful ; you er's tool and engrave a monogram on it, and it will look like a piece of molten gold. He was one of the greatest^operators any country can produce. I cautioned him at one time abrvit " that using too much gold. He said, You will get fooled on ; it looks so simple that you will be disposed to take it in pref- erence to any other form." It is most deceitful gold — it looks so easy to work, and looks so beautiful that sometimes you will not get the results you think you are getting. If you will exercise caution in using it you will get as good results from it as from any gold ever, prepared. DENTAL SOCIETY 69

Dr. Ramsay : I would like to ask whether crystal gold ever discolors the teeth?

Dr. Harris : I have never observed anything of the kind.

Dr. Carr : I have a stack of letters in my office written in answer to letters about the discoloration of o-old — letters from Dr. Watts. In several instances he had discoloration and before he got this new process — sometimes a little bit of quicksilver was left with the gold and the gold was thereby discolored, but after he got the new process of manufacture he never saw any discoloration. Sometimes, he said, with your burnishing you would still leave a little tarnish on it, but certainly for twenty years there has been nothing of that kind.

Dr. Harris : Under the present process of manufacture and with careful manipulation I do not think there would be any discoloration. I think Dr. Carr has explained that, with the present method, there is no possibility of haying any

impurity in it . I understand that nine hundred and ninety- nine parts in every one thousand are pure gold. It is as pure as gold can be manufactured, and precludes the possibility of any impurity in it. Dr. C. A. Bland read a paper on "Cohesive Gold and

Amalgam," as follows :

COHESIVE GOLD AND AMALGAM.

Operative dentistry requires a thorough knowledge of every branch of the profession. The prevalent idea that filling a tooth is a mechanical procedure pure and simple is a mistake, not only made by the laity, but by the initiated as well. Students often make the time- honored remark, " I am not much on theory but the real thing when it comes to the practical part." I am not endeavoring to belittle the wonderful gift of mechanical skill, the sneering book-worm who looks on constructive ability as being nothing but mechanical and conse- quently unworthy of his notice, shows an ignorance as great as the man who scorns all theoretical knowledge. The well equipped dental surgeon must combine the two — he must have the necessary mechanical skill ; also a perfect knowledge of the various theories, otherwise he cannot attain the highest distinction as an operator. We are often referred to men who have been successful without having had much education, such men would succeed, no matter how great the diffi-

culties ; they do not succeed because they have been deprived of advantages, but in spite of that fact. Every dentist has his own special methods of operating, his favorite materials, appliances, etc. I wish to say a few words about the use of amalgam and cohesive gold. I realize I am handling an old, threadbare subject. I have no hope of gaining anything new or original. I simply wish to bring out a few points with the hope of eliciting some discussion. First I should take up amalgam; the most used, the most abused of all filling materials, I believe. Back of the second bicuspids when properly inserted 70 PROCEEDINGS OF NORTH CAROLINA amalgam makes an excellent filling. It is easier to place a good amalgam filling in an inaccessible cavity than a good gold filling, and a perfect amalgam filling is superior to an imperfect gold filling. The nervous strain on the patient is so much less in filling with amalgam and this is a matter which does not receive the consideration it should. It is a mistake to inflict suffering merely to demonstrate our ability to place a good filling in difficult cavities. This may be met with the argument that it is better to fill once for all, but if we exercise the same care in the preparation of the cavity for an amalgam filling as we would if we intended to fill with gold the permanency of the operation would be assured. However, everything considered, gold is decidedly the most dependable material used for the preservation of the teeth. It has some drawbacks, namely : It is a good conductor of heat and cold and it is unsightly when placed conspicuously in large cavities in the anterior teeth. Cohesive gold, I think, gives better results than non-cohesive. I cannot understand the advantages claimed for non-cohesive gold. Why is it considered a good quality to have the different particles fail to cohere ? Why is it a disadvantage to have them cohere ? I know there are some men who are so skillful in the use of non-cohesive gold that they make contur fillings which are perfect, but such manipulative ability is limited to a few. In the hands of the average dentist cohesive gold certainly gives the best' results. In the preparation of cavities I follow the usual methods, resorting to extension for prevention, also against recurrent caries. There is one point I wish to bring out, that is the great necessity of the proper knuckling of approximal fillings in order to prevent the lodgement of food and forcing same into the interproximal space. In a normal mouth the contact point of the teeth is so arranged as to give protection to the gingiva, but when caries occur and approximal cavities have formed lodging places for food we frequently find inflammatory conditions or else wasting away of the gum tissue. When we restore these teeth to their original form, we must make the contact of the fillings so exact that it is next to impossible to force anything between them. The present day strenuous life is developing highly wrought nerves, and the forcing of fibrous matter into the interproximal space is frequently a source of great annoyance and discomfort and must be guarded against. Another consideration is along the line of aesthetics. In this the shaping of the cavity is the all important part. Square irregular margins always attract attention, in fact, an oddly shaped filling is more noticeable than a larger one with graceful outlines. Curving lines always give the best appearance. Often we make the mistake of attempting to save too much tooth structure although it is never admissable to needlessly cut away enamel or dentine, but it is much better to do so than make an unsubstantial filling, or one with an " irregular outline. I recently read an article which said that the day will come when the gold filling will be classed as belonging to the barbaric period of dentistry." Porcelain or something else which from an aesthetic standpoint is superior, will supplant it. That the dental profession will attain such artistic skill, nature will be simulated so perfectly that the artificial cannot be detected. Let us hope that the dawn of this day of dental perfection will not be long delayed. DENTAL SOCIETY 71

DISCUSSION.

Dr. Harris : I call attention to his question concerning the use of soft gold, " Why should we use it at all?" I think there is an arrangement under which soft gold is applicable. I use it in my practice with advantage in regard to saving time as well as in saving the teeth. If we can do a thing in less time and do it as well I think we ought to do it in the best way and shortest time. We can use to a large extent soft gold in a number of cases in cavities in incisor teeth, but it requires a greater amount of skill than to use cohesive gold. I do not think the colleges are paying attention to soft gold as they once did. I have heard those who are lecturers in the colleges admit that fact. They say we teach the students one thing, but practice another in our offices. One of the most prominent operaors told me that. Somehow it has gotten to be the pop- ular thing to use cohesive gold, and we have just to follow in line. We must exercise judgment and learn how to use it. The further we get from old time practitioners the more we know of its use. We know that cohesive gold can be made to apply to the contour to a limited extent, very few of us are favored with that amount of skill. I have seen it done. The use of cohesive gold is an important subject and I trust it will be brought out in its various phases. I have presented the only form of gold in which I was interested. I simply differentiated in presenting my own subject. I would like to emphasize the point brought out by Dr. Bland, that we should exercise great care in putting in fillings ; and the same when we insert gold fillings of any kind or character. And we ought to use great care in the preparation of the margins. In mixing the material do not use it in a mass ; and do not work it in with the finger, but use care in every step of the operation and then you will get good results. I like the idea of cohesive gold, although I like soft gold too But the idea of cohesion — no cohesion means it does not hold thing looks against soft gold, together ; so the very idea of the as if of less valuable material. Cohesive is a good term — something that holds together and makes something that the public can understand. We have to be careful in the language we use to our patients.

Dr. Turner : I do not have very much to say, but it strikes me that it is hardly reasonable that we should explain to our patients the meaning of cohesive or non-cohesive. And I will call Dr. Bland to account for a certain amount of inconsis- tency. He gets up here and tells us to spare our patients — 72 PROCEEDINGS OF NORTH CAROLINA

spare them from nervous exhaustion and all that. I use cohesive gold, but it takes about three times as long as it does to use non-cohesive gold. I am conscious of the fact that the prevailing sentiment of this Convention is against my theory and my practice in this regard, but I have never heard this subject discussed that I have not raised by earnest protest against these prolonged operations and the theory of cohesive fillings. It is no answer to say that a part of it is non-cohesive. In many cases I use a soft cylinder to start my filling and fill the balance with cohesive gold, and I believe the trend of sentiment in this country has been to discard the use of cohesive gold in almost any filling.

Of course it requires judgment to make it fit, but the mechanical construction may be so perfect that we can use three-fourths of non-cohesive gold with the filling. I admit the fact that the instances which come to us from the clinics — they invariably prefer the use of cohesive gold, and why ? It is a very easy mathematical problem. When you have a cavity and you drill a few retaining points and you get these

points filled then you do not concern yourself whether it will get out or not because you have got it with the pot legs and there is no chance for it to get out in a short time. But it is the adaptability of the gold to the walls of the cavity that is the important point in the filling — you have got to make

r it tight, and } ou can do it more easily, with less strain on your patient, and put in larger quantities of gold with non-

cohesive gold to start with ; but I have never seen a man who would agree with me. I get the facts from the best practitioners in the North who have for years and years advocated the use of cohesive gold, upon its discovery by Dr. Arthur, of Baltimore, and I have heard him make the statement that you could develop the cohesive quality of gold, and that was the reason why it was not equal to soft gold. In reality it is superior to non-cohesive gold, and equal to soft gold, because the particles cohere in such a way that you could not make the impression. The practical point is this: those fillings that protect the walls of the cavity by fitting most accurately are made mostly of soft filling. I state that as a scientific fact. I have had the experience of nearly twenty-five years and I have never seen any cause to regret that I adopted the use of non- cohesive gold in my practice many years ago and continue up to this day. I have used it in almost every cavity which would take cohesive gold. I do not think it is necessary to go into DENTAL SOCIETY 73 the details of the operation because we haven't the time, and that is not the subject under discussion.

Dr. Judd : I want to say I hardly see the force of what Dr. Turner has said about non-cohesive gold in the combination with cohesive gold. I find by its use I can get in a filling, very often, in half the time — at least in two-thirds of the time I could the other way, and get a better filling. I can build against the walls, but not as strong as with the use of cohesive gold. I have heard some complaint that it would not cohere, but if the non-cohesive gold is put in and thoroughly condensed with a sharp plugger hand instrument, and take a very thin strip of cohesive gold and work it into it with hand pressure and condense thoroughly you can fill the cavity with cohesive gold and get a perfect fit.

Dr. White : That is my experience. I use non-cohesive gold but it will not cohere unless it is annealed, and then it is as good as cohesive filling. The only difference in the fill- of ing is this : We expose it to some alkaline gas — fumes amonia I suppose — I do not know — but if you put it in a flame it drives that all off and makes it perfectly cohesive.

Dr. Betts : If I have any success in combination gold fillings it is due to Dr. Patterson. I remember when I first asso- " ciated myself with him I had to make my " pot-legs and hold my filling steady with an instrument in my left hand, and I used to get worried, but he taught me how to use non-cohesive gold. Last February I was at our Southern Branch meeting in Washington, where I made a clinic — a gold filling, using non-cohesive and cohesive gold ; and I was very successful in getting it built up with a beautiful contour.

Dr. Bland : I feel very much in the position of a fellow who was running for office ; when they asked him about the result he said, " The majority against me is large and enthusiastic." At the same time I think cohesive gold is the best filling material. I have seen so many men who claim to use non-cohesive gold almost altogether — annealing it to make it cohesive, and then use it in the same way you do cohesive gold, and they call it non-cohesive. I have heard that expert operators in this country use glass tubes to fill them. I think the majority of men who use non-cohesive gold anneal a great deal of it, and I have seen some combination fillings that have split off. They put in their non-cohesive gold and build on that and after awhile it split off. I do not claim that cohesive gold is the only gold. More people use cohesive gold successfully than non-cohesive. Go to the manufacturers and you will find 74 PROCEEDINGS OF NORTH CAROLINA

they sell twice as much cohesive gold as non-cohesive, showing that it is more extensively used by the profession, and you can certainly build up the teeth with it in better shape. I think the reason so many fail is that they try to save too much of the structure. You cut away the tooth and build it out with gold and there will be no recurrence of caries — it is a prevention. Of course you must use moderation in all things.

Dr. J. E. Tucker read a paper on Dental Ethics and Juris-

prudence as follows :

ETHICS AND JURISPRUDENCE.

Ethics, a system of rules and principles of duty. The moral philosophy which teaches to men their duty to society and to themselves. All conditions of social life are governed by ethical rule. When we take the code of dental ethics, we find a vast compre- hension in ethical rule in its relation to the practice of dentistry which I cannot attempt to explain or discuss in this short paper. There is a seeming indifference and want of attention to ethical study, and I believe one of the reasons for this is, the accepted mistaken impression that every person presuming to practice a profession, should be, or is an ethically cultivated person. If the philosophy of the rules of ethics were more diffused among the institutions of dental education, it would be conductive of more congeniality, good fel- lowship and refining influences of an elevating character, from which professional gentlemen would not descend. To be ethical is to practice the rule of ethical deportment in what you do, and what you should be. It is philosophy when we study laws and reasons which should prompt our actions toward society ; it is ethical sentiment when we " do unto others as we wish they should do unto us." The essence of true ethical philosophy is the impression made upon a community by the honor and integrity of a gentleman. Morality in dental ethics embodies the exercise of conscientious principles, equity, honor and truth. It is far preferable to be looked upon by society, as morally truthful, kind and conscientious, than to be considered elegant in person and of seductive manners. Every dentist should endeavor to have his office to contain the conveniences of privacy and comfort, free from display of gorgeous furnishings, which oft-times embarrass and convey the idea of extravagance in charges to many. The reception rooms and whole office should show the proper appreciation a dentist entertains for economy of time, and his patrons' comfort. There should be no display of implements or instruments, charts, maps, and human skulls, as such displays often terrorize, intimidate, and are repulsive to many. Care should be given for a scrupulously cleanly condition and appearance of the entire office.. Conditions and appearances usually depict the taste and character of the proprietor. The first impressions made upon the patient has much influence, favorable or unfavorable, and the first impressions are often the most indellible. And so it follows that every dentist ought to possess elegance of manner. However, with these requirements, a proper distinction must be observed DENTAL SOCIETY 75 between what constitutes true elegance of manner, and in what might be construed into or considered self importance, arro- gance, haughtiness, or bombastic dudeism. Simplicity of manner is true elegance, as it is far from ethical to evince a manner of conceit. The temptations to be professionally dishonest, I am sure, must be as great and as varied to the dental surgeon as those that come to members of any of the other learned professions, but I am sure that experience and observation will justify the assertion, that in. the end it pays to adhere to ethical principles and honesty of action. " Not professional honesty, with the mere commercial quality that impels men to pay just debts and refrain from wronging his neighbor, but the higher and nobler spirit which makes the professional man scrupulous to a nicety in everything pertaining to honor and truth in verity.'' I do hope to say something in this paper that may impress your minds with the importance of honest and ethical conduct toward students and young practitioners, who look to gentlemen of high standing in this society as guides, examplers, and friends. The temptation to stray from the narrow paths of rectitude, which comes to the young practiioner in our profession is more strenuous than is generally supposed. When a young man first starts with a small practice, the struggle " is hard, dollars look very large, and professional debauchery usually comes in the shape of seductive dollars," but, young men, I urge you to have moral stamina, honesty and foresight, and in the end you will realize that in professional life " honesty is the best policy," as it is the right principle. Measure your answers to patients and guard against criticisms or comparison of another dentist's services. Remember that it is unprofessional to advertise in cards, hand-bills, posters or by calling attention to lowness of prices, special modes of operating, or the claim of superiority over other practitioners and cutting prices on your brother practitioner, etc. _ The true character of* man, even when naturally just and noble, requires culture and refinement in order to comply with the demand of true ethical deportment, which compels many acts of self-denial and sacrifice. Therefore I urge you to meditate on these requirements and educate yourselves to a compliance as near as circumstances will allow you to do, realizing the necessity of an early culture of habits and manners that will help you to practice dentistry in accordance with the rules of true ethics. In this great commercial progressive age, when society is highly organized, we may find ourselves at any time in the shadow of the law in the courts, as plaintiff or as defendant, defending or opposing an encroachment upon our rights, for acts done in the sincere belief that we were doing right when we did the thing. This brings us to Dental Juris- prudence. Dental Jurisprudence is the science which teaches every branch of dentistry to the purposes of the law, hence a thorough knowledge of the studies that composes the course in Dental Surgery, and the requirements of the law. So dentistry, like other learned professions, is not exempt from acquaintance with the law. Those who, by authority of the state and your vote, have the honor of compos- ing the board of dental examiners of this state, have had an acquaintance with the law and are at present in its courts, for carrying out the law, as they interpret it, from the acts of the legislature govern- 76 PROCEEDINGS OF NORTH CAROLINA ing the practice of dentistry in this state. There is a principle which applies to all learned professions, and that is that every dentist in performing an operation enters into an implied contract with his patient that he possesses that degree of skill, having that experience which is ordinarily possessed by others of his profession, having knowledge of the advanced state of the science of dentistry, and that he must use reasonable care and diligence in the treatment of cases trusted to him, using his best judgment when in doubt as to the course best to pursue in the treatment. The law does not imply a warranty. The law places no limit to the value of services rendered by the dentist. The dentist with discretion estimates the value for services rendered and names his own fees, and when his patient is sued for the value of such services, is adjusted by the jury. The legal limits of the dental domain is a question upon which our ablest men differ. My opinion is that we would be safe to include in the professional duties of the dentist the care of the teeth when sound, the treatment of their deformities when unhealthy and unsound, and the adaptation of proper substitutes when by accident, disease, or age, they are lost. Of course we must include extraction, filling, implantation, replantation, trans- plantation, and other operations treated surgically and medicinally. The dentist must be competent to perform any operation, treat any disease, or pathological condition pertaining to the dental organs, adopt and practice such systematic treatment as the body of the profession practices. If he lacks this or neglects to use skill and knowledge in a reasonable manner, he is liable for malpractice, should' serious results follow an operation. A higher responsibility is placed on the specialist ; he is required to use the highest skill and knowledge his profession has attained on the subject. A dentist cannot be compelled to render service to a patient, but when once he has taken the case he must continue his services unless dismissed or other services can be obtained even if his services be gratuitous. The dentist also has the right to charge for time lost for an unfilled engagement. He also has the right to retain made or repaired sets of teeth as security for reasonable charges. An eminent practitioner with experience and reputation may demand a larger fee for the same service than a less experienced practitioner. The nature of the case, the circumstances under which the services were given, the difficulties and expense attending them and the responsi- bilities devolving upon him, regulate the value of the services of p professional man. This is a large subject and there are many points of interest that I might mention, but I have kept you long enough. In conclusion, I would say that the law affords us much protection, great latitude for operations, and greater respect for our work, from a pecuniary standpoint than is generally supposed, and we are to blame if our profession does not receive that esteem and respect that it should I thank you very much.

DISCUSSION.

Dr. R. H. Jones : This is a subject of very great importance and I had read Dr. Tucker's paper before hearing him DENTAL SOCIETY 77

read it here. It has many points of interest, and there are two points of special importance to us. The first is our conduct towards each other as dentists. We ought to be very careful in our conversation with our patients in regard to our brother practitioners. We cannot always enter into the circumstances of the cases that may come to our attention, and the facts are often so different from what we hear. Something has been done by another dentist — some operation has been performed that does not seem right, but we cannot understand it unless we know the circumstances. There is only one thing to be done in such a case and that is to say nothing about it. Criti- cism of other dentists is entirely out of place if we wish to practice in an ethical manner. If we cannot say anything good about a fellow practitioner it is a good plan to say nothing. It " may be a trite saying, but it is an old one, Do unto others as we would wish to be done by." The other phase of this question is our duty to our patients. noth- They are entitled to our highest and best service ; to do to about other ing that is shoddy ; nor make remarks them dentists. Our patients may have fallen into the hands of practitioners who have not done for them the very best things, but generally speaking we can get along with that class of people by saying nothing about them. This question has a wide field, as Dr. Tucker has just said. The Examining Board has had a little experience in our courts, and this is a question that has not been too much discussed. The duties of the Examining Board are very burdensome and onerous. It is our duty to admit no man to practice who is not qualified to stand the'State examination. I feel, Mr. President, that I had better leave this subject in the hands of others who are better able to talk on it. of the Dr. Horton : I heartily endorse the statements paper and the subsequent remarks by Dr. Jcnes. I think we should be very lenient to all practitioners because we do not always know the conditions under which certain operations that are criticised were performed. I dare say we all have had patients who were so nervous we could not do as good work for them at one time as we could, say, a week later. In our town we have a local society, and I am sure there is nothing that promotes good feeling among the fraternity more than this. We get along much better — there is less criticism of each other. We should be more guarded about the remarks we make about the work of others. I Dr. Everitt : It is bad to talk about one another ; and 78 PROCEEDINGS OF NORTH CAROLINA believe most of these things are started as insinuations, and then they keep on their vile work like leaven in meal — it works all the time, and it is worse for a man than straight out remarks against him, because when one makes straight statements about another that are injurious we charge them up to envy or jealousy — though no gentleman will do this — but insinuations work all the time. I agree with the sugges- " tions about a local society. I think Raleigh " takes the cake in the matter of having started a local dental society and in keeping it up. We adopted a black list long ago and it works beautifully. As to jurisprudence I am hardly prepared to talk about that. It is a vast field, and we could profitably spend four or five hours on that line.

Dr. Spurgeon : When we can get along with less talk about each other's work it will do more to help on our profession than anything else we can do. I would like to hear from Dr. Turner on this subject.

Dr. Turner : I think I know when I have had enough of jurisprudence. Subject was passed. The following applicants for admission to membership

elected : were duly J. T. Pittard, W. E. Snipes and J. E. Warren. Dr. W. B. Ramsay read a paper on dentistry From a Busi- ness Standpoint, as follows :

DENTISTRY FROM A BUSINESS STANDPOINT.

Mr. President and Gentlemen of the North Carolina Dental Society : It affords me great pleasure to be present at this meeting and present to you a paper on a subject of which I have learned some thing by personal experience and observation, and more perhaps by the experiences of my fellowman. To many and possibly to all, there will be nothing new set forth in this paper, but possibly it ma\ cause some one to stop and think who otherwise would not. Every occupation in life has its practical business and theoretical sides to

deal with ; it is the former with which I wish to treat, without which no business can be carried to a successful issue, be it dentistry or anything else In applying this subject to dentistry, it will be found that it is not always the man who can do the most artistic piece of work who is always the most successful, but the man who has combined with that of fair skill, a good degree of tact, adaptabilty, forethought and insight as to people and conditions surrounding him will generally be found in the front rank of the profession, and is head and shoul- ders above the man who is all theory without that practical knowl- DENTAL SOCIETY 79 edge of the common every-day affairs of life and judgment concerning human nature. Without buisness methods sensibly applied, one can never hope to reach that point of success, in his professional career, that is possible to the man who puts such methods into practical use. There are many men in the profession today, who are enjoying large and lucrative practices, who do not possess any more professional ability than their next-door neighbor (who is possibly living from hand to mouth) but who possess the qualities of true manliness, affability, kindness of heart, and that something which we may call magnetism, that draws mankind to him and causes them to trust and believe in him. Sincerity, truthfulness, honesty of purpose, and candor will surely and securely intrench one in the confidence and esteem of those with whom he has to deal. Therefore it stands us in hand to be straightforward and honest in all that we undertake to do ; not alone it is true for the good returns that it is sure to bring, but for the sake and comfort of an approving conscience as well. You may deceive yourself in thinking that a small sized falsehood here or there to cover up a mistake or carelessness in some operation will not make any difference and by the use of such a method you can satisfy your patrons and save your own lazy bones a little hard labor. your Be not deceived ; you may think that you have covered up tracks, but not so ; because you have not been contended with or contradicted in the matter, and your patients leave you in an apparently good humor, you may pat yourself on the back and think everything is lovely, while at the same time your patients know as well as yourself that they have not been fairly dealt with, and that you have lied, which will not foster a very enviable reputation. I do not think there is anything that will promote the cause of dentistry more, or that creates a greater demand for the services of the profession than that of honest, efficient service on the part of the practitioner, and if you cannot or will not render such service, it were better for yourself and the profession that you try to find your proper sphere in life, for in this you have evidently missed your calling. You have no right to take the hard earnings of your patient without giving full value for it. It is a well-known fact that every walk in life has its honest, efficient men, also its dishonest and inefficient ones ; the dental profession is no exception, but because your neighbor is a quack and advertises all ethical men as a band of robbers, and that he is merely living to look after the interests of the dear people (?) and possesses the only really scientific anaesthetic known to the world for the painless extraction of teeth, and that he will extract your tooth for twenty-five cents and throw in an automobile ticket besides, is no cause for your taking fright and dragging your profession through filth and mire to keep pace with a man who would not hesitate, for the advancement of his own selfish purposes, to destroy every atom of respectability and dignity which the honor- able and honored men of the profession have labored so hard and long to foster and maintain. It is not the charlatan who gives respect, dignity, and integrity to the profession, but the zealous, self-

respecting ethical man ; and I believe that the better people are beginning to find out more than ever before that he is the life and backbone of the profession, and in him lies their hope of continued efficient services and protection. If it were possible for the man 80 PROCEEDINGS OF NORTH CAROLINA

who conducts his business on commercial lines to shape the policy of the profession, it would not take long to bring it to the point where the village blacksmith would receive the greater respect and justly so. There are many other things that might be profitably set forth in this paper, some of which are the prompt rendering of your bills and collection of accounts, your own personal appearance and that of your surroundings, your duty to the community in which you live as a moral, public-spirted, enterprising citizen. But to develop all the points that might be brought out in this paper would, I fear, make it too long, so I will mention only one other, and that is your duty to your State Dental Society. We should all strive to build up and not tear down the noble structure of our calling that has been builded at such a great cost of time and money by the self-sacrificing men of the profession, who have given freely and ungrudgingly of their time and talents for its advancement and upbuilding, and thorough organization is the only way in which this can be practically done. One cannot attend the meetings of this Socety with any degree of regularity without being greatly benefited in a practical way, and having developed in him a greater love and concern for the welfare

of the profession ; therefore, it behooves us to stand uncompromis- ingly by the organization that has made dentistry in North Caro- lina what it is today, and is her hope for the future.

DISCUSSION.

Dr. Hunt : I have listened with pleasure to the reading of this paper. Every vocation, it seems to me, has its business aspect as well as its professional aspect. Every vocation has its professional aspect but not always in a marked degree. When I say that I do not wish to speak at all disparagingly of any of the professions, though I do think that every vocation ought to have some attention given to the business side of it. Probably one reason why so many of us give so little attention to the business aspects of our profession is because we have had no training in that line. The college curriculum does not include business training. About the last thing we hear the professors say is something about dental ethics. In conduct- ing a dental practice it seems to me that everyone ought to have a business system — conduct it along business lines as a merchant does his business, enter up transactions so that we can turn to them at once and know how each one stands. It is my custom to strike a balance sheet at the end of every month, and in this way I can tell in an instant how my work is standing, and can compare it with what I did the previous month, or with the corresponding month of the year before. In regard to sending out bills, I think the suggestion is a very wise one. Bills should be sent out promptly — I DENTAL SOCIETY 81 mean on the first of the month after the work is completed. The plan of collecting after each separate operation is very dis- tasteful to me. I do not like to do it, though of course, it is necessary to use discretion in this regard or in some cases we should never collect our bills. When I knew what the subject of this paper was to be I was afraid that something might be said concerning the fees charged by different dentists. I was very much gratified to know that Dr. Ramsay said nothing about that. Each dentist has a perfect right to charge whatever he pleases — place his own value on his work, and if the patient is satisfied it is all well and good. points in it, Dr. Osborne : The paper has some excellent and the main point is what we should do as members of the Society. It has been told ten thousand times what we ought to do and we ought not to forget it. Of course we do what best serves our Society. I am proud of the North Carolina Society. I want to emphasize the point that we ought to be careful in what we do as professional men, and try to hold up the Society and make it better each year. We ought to be thinking about these things, and I want to say that you need not expect a big attendance at these meetings when you hold them in an extreme portion of the State. From my home it return too required about two days to go and two days to ; much time lost. this discussion I have Dr. Ramsay : I think in closing nothing further to say on the subject. Subject was passed. paper on Occlusion and Reten- Dr. J. N. Johnson read a tion of the Permanent Teeth Considered in Relation to Ortho- dontia.

OCCLUSION AND RETENTION OF THE PERMANENT TEETH CONSIDERED IN RELATION TO ORTHODONTIA.

Mr. President and Gentlemen of the North Carolina Dental Society : In preparing and reading a paper on Orthodontia, I do so with the mind easily full knowledge that things not kept constantly before the question slip from memory's grip, and the more complicated the involved, the weaker the grasp we get upon it in passing. Partic- in remarks ularly is this fact true of the study of Orthodontia, and my concise. upon this subject T shall endeavor to be brief and retention of the perma- I shall consider herein the occlusion and preserva- nent teeth for the development of the dental arch and the tion of the natural expression. 82 PROCEEDINGS OF NORTH CAROLINA

Our first difficulty, mayhap, will be found in an an effort to overcome the natural antipathy of the patient against regulating appliances and their concomitant inconvenience. We should address ourselves to this task patiently, and by kindly explanation of the good to be accomplished, endeavor to win the patient to a faithful observance of instructions. We are unlikely to become skilled specialists in this branch of the profession by reason of a restricted clientele. Cost, the unsightly appliance often necessarily visible, and the .annoyance attendant upon wearing it, are potent factors in restraining many a prospective patient from becoming a subject of orthodontia. However, I take it to be our duty as dental practitioners, to familiarize ourselves with different the malformations of the superior and inferior maxillary ; and, having determined the cause, proceed to its correction in a logical manner. Hardly a day passes that we do not make a mental note of how lamentably nature has erred in the fulfillment of its primary intention. And how regrettably has its progress often been marred by a premature extraction. The forcep artist is far too often prone to follow the easier method of correcting irregularities. He does not stop to consider the fact that each extraction before full permanent eruption is sacrificing the maxillary development and narrowing the arches. In a corresponding ratio with the area of the extracted molar, bi-cuspid, or incisor, it destroys, to a greater or less extent, a perfect occlusion. Further, it frequently weakens those lines of the face which denote strength, character and firmness. Correct occlusion or cusp interdigitation and the consequent perfection of facial expression is the goal for which we should ever strive. Hence it is important that we consider the relation of the cusp, each to the other, in the teeth of the upper and lower jaws, and the result when its perfection is disturbed by extraction. For example, take the first year molar when extracted at an early age, or before the second year molar has fully erupted: We will always find the second molar following its natural inclination toward the medium line of the face, and moving forward into the space of the extracted first molar. The six anterior teeth assisted by the force of muscular contraction upon the growing bone, move backward and inward, thus retarding in the lower jaw the development of the mental eminence, and in the upper, the canine eminence — that essential portion of the facial frame without which the development of the face has lost its most important adjunct to expression. Among the common malformations aided instead of corrected by dentists is the extraction of the lateral incisors where the cuspids have been crowded out of the arch. This produces an unnatural or tusk- like protuberance, and it is in such cases that we often find the lateral incisors removed, particularly when this tooth is peg-shaped, decayed or rotated in its socket out of the elivial line. Extraction of the lateral permits the cuspids to drop into line beside the central incisors and the result is, we have condemned our unfortunate patient for all eternity to a dog-like or canine expression. This extraction,, by dwarfing the formation of the canine eminence, obliterates the strongest line of the expression. In regulating it often happens that the idiosyncrasies of the patient, and the other environment of the case, leave us no recourse DENTAL SOCIETY 83 but extraction (which I never advise) but I maintain when this is obligatory, it is never necessary to extract the cuspid or lateral. On the contrary we should get the desired space by the extraction of the bicuspid. We can at least save the root of every healthy lateral incisor in all cases without endangering our objective. A suitable blade can be attached to this root thus retaining the delicate lines of harmony — the obtainment of which we are seeking. In all cases of malformation we should consider the correct occlusion with a view to restoring the teeth to their respective places in the arch, thus exerting (especially in young patients) the necessary developing force upon the growing bone.

DISCUSSION.

Dr. R. L. Ramsay : The subject is worthy of our best thought for it is a branch of our profession, and is rapidly developing into a science. I have heard the paper with a great deal of pleasure and profit, and I do not believe the progressive dentists of this body will allow the subject to pass without a thorough discussion. There is no branch of our work that is causing a greater elevation of our profession in the minds of the laity than orthodontia. In regard to appliances — that is something that depends largely upon the skill of the operator, and the convenience the patients derive from wearing them. Dr. Alexander's hood crown is a very good appliance for holding in position some teeth. I had a case of two laterals to be moved forward into line. I bound to the surface of the anterior teeth a narrow strip of gold such as is used in constructing a crown, burnished and held snugly to them on the palatine surface. After being cemented to position it was worn with perfect convenience to the patient. There seems to be much diversity of opinion in regard to extraction. One of the most prominent dentists in the South showed me his child's mouth from which he had removed all of the first permanent molars. This method is advocated by the most eminent writers where the teeth are defective and where space is needed. Orthodontia is a problem of mal-occlusion, and the position of the first permanent molar is perhaps the cause of mal-occlusion. Now is it ever justifiable to sacrifice the first permanent molar if it can possibly be avoided ?

Dr. Frazier : Where we have been almost compelled to extract one of the first molars, is it best to extract the corresponding tooth or the opposite tooth, to prevent irregularity?

Dr. Johnson : I do not see how it could help the matter — if a first molar on one side and one on the other side are 84 PROCEEDINGS OF NORTH CAROLINA removed — I do not see how it would help increasing the deformity, because we would have the anterior teeth going backward and the second molars sliding forward. If we remove one first molar, which I would be sorry to do, I think I would leave the other one.

Dr. Gorman : I think I would answer the question as Dr. Angles would answer it. He would say save the teeth by all means, but if anything had to come out, extract the corresponding tooth above rather than the one on the other side. It checks the growth of the mandible by extracting one on the other side. We as dentists do not consider as we ought the importance of saving these precious gems — these first molars. It is something very important and one of the greatest errors made in dentistry by the general practitioner in the extraction of the first molars. My experience in regard to appliances has been limited but I would say I do not use gold ; I use German silver, and make a very delicate little band, and place solder over it to strengthen it. Though you may have more surface to affect, if you will use a very small piece of wire and solder it on the back, even though it touches all the way across, the area is nothing near as great. I cannot lay too much stress on the importance of saving the first molars, and I think it is the duty of every dentist to watch these molars — watch the occlusion of them, and if they are seriously tilting one way or the other, and have not a normal occlusion in every respect, then go to work on them right away, as they are the main props to hold the contour of the face. One question that was a great stumbling block to Dr. Angles, and I think is to almost every one who practices dentistry, is, What are we to do when a patient comes with the first molar extracted at an early age — anywhere under twelve years — what are we to do ? If anyone can suggest anything to be done at that age I would like to hear it very much.

Dr. Everitt : The practitioner is frequently confronted with a proposition of this kind. In such a case, when the practitioner knows it should be saved, and wants to save it, and knows that the party is not able to remunerate him half enough to justify him in putting the necessary labor on it, or if he is able to pay but will not submit to the treatment necessary on that tooth, and he goes away and comes back again, and the case is growing worse all the time, I say go ahead and take it out. If you decline to remove it he will say he can get Smith or Brown to remove it, and he goes out of your office — you DENTAL SOCIETY 85 have simply got to lose this patient. You may make these suggestions to him, and explain why it should be preserved, and its removal would mar the beauty and integrity of the face, but the aching tooth knocks out all arguments and the tooth is removed.

Dr. Osborne : I'll tell you what you can do. It comes to us nearly every day. We all have patients of that age, young people from eight to twelve years old — that is the kind I am talking about. If no one has had better experience in saving them than I have I am sure he will pull them out — that is the best I can do. Of course if the patient is of middle age and is suited with your suggestion it is all right, but if he is from eight to twelve years old what is your success in saving such teeth ; they are dead, and what is your success in putting in a bridge ? I never saw any of that kind of work that amounted to very much. I would like to know how you do it. It is a very momentous thing that concerns the human family a good deal. If there is so much concern about it I want to know how you bridge it when you extract the tooth, and if that ever suits the patient ? As far as my recollection is concerned he gets along — he chews the same on the other side, and he has no tooth-ache, and he becomes the best patient in the world. But if anyone can save a tooth at that age I would like to know the procedure.

Dr. Livermon : My experience in this matter is somewhat limited. First molars, when all the other teeth are intact are the hardest teeth to manage. In this Society has there been any success in saving first molars ? You kill them and fill them and crown them — sometimes we fellows do not do much crown and bridge work — and sometimes we find one of these first molars will get loose and then the whole work that we have put on it is a loss — the tooth and all. A satisfied patient is a mighty good thing, and a good night's sleep is a mighty nice thing for that boy who has had a tooth-ache. I have in my practice some young people who are hard to get into a dental chair — but they come with their first molars in bad shape and I extract them. I supposed it would be a hard thing to get them into my office again — children, say ten years of age — but they will come again. A ten-year-old girl — you can appeal to her, and I can get her a little earlier than I can a boy. Seventy per cent of my patients, from six years old to eight or nine, for whom I extract first molars, when they come back to my office their bicuspids have come in place, and I find the bicuspids better teeth and easier to take care of in 86 PROCEEDINGS OF NORTH CAROLINA

the years to come ; seventy per cent of them will never have so much deformity — I don't care if you extract one or more. Sometimes I extract one, sometimes two, sometimes all four — it depends entirely on the age of the teeth, the age of the patient and the temperament of the patient.

Dr. Wheeler : I have not kept a record and do not know what percentage of my cases have been saved, but I will give you a little history about my own mouth. When I was eleven years old I had a sore first molar and I went to a dentist and had it extracted. What is the result ? The second molar has tipped forward and closed up the space above the gum margin. it I wear a gold filling in that cavity now ; the last time was filled was about two years ago. When the first molar on the right side began to give me trouble he said I had better have it filled, and I did so and the result has been perfect comfort to this day. child Dr. Gorman : Where you have a large cavity — the is, say eight years old, and the nerve is not exposed, would it not be far better to save that tooth and leave it until the patient is eleven, or eleven and a half and then extract it if the patient is not able to have it treated ? I have a model in my own mouth which I will show. I had the misfortune to lose one of the first molars when I was ten years old. The molar is tipped forward and I have no occlusion on the right side. Dr. Alexander: About the extraction of first molars, we depend largely upon the condition in which we find the teeth. Take a tooth that is very poorly constructed, if you attempt to save it by filling and re-filling, the nerves will die and you will lose the tooth at a riper age. I was very much worried to know what to do with the teeth of my own children. I wrote to several gentlemen of reputation in the North and they advised me to extract all four. I did so, and I hope some day you gentlemen will have an opportunity to see the results. The articulation of the little girl's teeth is almost perfect now and I believe it will be perfect in a few more years. I extracted them at eleven, I think. I should have done it at the age of ten — all four molars in both cases. The girl's teeth showed occult presentation in front and it has improved her appearance very much. The boy has that hatchet kind of face which worries me some and I would like to know how to remedy it. let I think I will make a band and put around his head and those him wear it every night — it may help that. I extracted out not only in teeth because I was forced to do so ; they came one, but in four or five different points — I do not know DENTAL SOCIETY 87 why. The deciduous teeth came out perfectly and remain so. The second molars since that have come out perfectly, and there is not a decayed tooth in either mouth today. If you extract one tooth it will certainly lead to another operation. If you extract one, I think it would be a good practice to extract all four.

Dr. Gorman : What would Dr. Alexander do where the patient is thirteen or fourteen years old?

Dr. Alexander : I would save the molars if possible.

Dr. Gorman : I have had the pleasure of seeing Mrs. Par- ham, a patient of Dr. Alexander, who came to him at the age of 36, and he moved the molars back and gained the space of the first molars, and has obtained wonderful results.

Dr. Livermon : Do all of you gentlemen fill the canal in the anterior root of a molar ?

Dr. Alexander : About saving these teeth up to the proper time, I have never decided when they should be extracted, but I take them out at about eleven years of age. In some cases they are so badly decayed that we know they will not stand that length of time, and up to the present time we have found nothing to sustain these teeth until Dr. Ames prepared his cement. At the time I treated these cases, and before I got the views of an expert, I would simply make no effort whatever to fill them but clean them out, as well as I could, and paint them with nitrate of silver from time to time. In my family, where I had them constantly before me I did stop the decay of those teeth, but when I extracted them those cavities had a line of black, like a black silk thread, from the cap, due to the painting with nitrate of silver, and it would beat the filling, two to one — that is, in the first molars.

Dr. Johnson : When I mentioned the first molars I had in mind our friend Osborne, because we heard him on that same subject — he believes in pulling them out. Of course we must do what is satisfactory to our patients. Sometimes it is a difficult thing to do, but if we have three good first molars — only one is decayed — I do not believe in sacrificing all four.

Dr. J. H. Brooks read a paper on Clean Hands in Dentistry as follows :

"CLEAN HANDS IN DENTISTRY."

As this paper is only intended to suggest a few practical helps and hints, we trust the hearers will excuse the many little digressions which may seem out of place. It may appear to some of you as a sort of an insult for one to 88 PROCEEDINGS OF NORTH CAROLINA conclude that any of us as professional men should need any suggestions pertaining to this subject, or that the subject is not of sufficient importance to spend time discussing it. Who of us do not have to put our hands through the wash a dozen times a day ? Or do we know of anything our patients appreciate more than for us to come to them with clean hands ? Then if it is something claiming our attention every hour in the day, let us exchange a few thoughts upon the subject. The daily care and attention to the nails is a highly important duty hard for us always, ever and under all circumstances to keep in mind, especially so when we have several hurry worry days to come all along together. To couple this daily attention to the nails with some other work which requires our daily performance will often save us from neglect along this line. This is to spend the first five minutes after we enter the office in the morning : at first wind your watch as a reminder, next cleanse your own teeth and oral cavity, and last but not least, give your finger nails a close inspection. It will soon become as fixed a habit as it is to take the key from your pocket to unlock the office door. We can never do better for ourselves and our patients than begin the day's work with these three little details. It prepares us with the hour, it may often save us the remorse of finding ourselves on the point of thrusting our dingy nails into the mouth of some watchful and sensitive patient. It is also the proper time for us to thoroughly cleanse our own teeth and oral cavity, that we may not disgust our patients with disagreeable odors from our own mouths for we know what a feeling of disappointment and bitter surprise steels over us when a nice lookng patient, with an air of refinement enters the office and takes the chair, and we are almost pushed back by an odor from their mouths, caused by neglect. Then how much more should an intelli- gent patient expect of us along this line than we may expect of them. It is also well for us to look after these conditions in our own mouths several times during the day, especially any of us who may be troubled with any form of indigestion. Our hands are often cleaner than they look but our patients don't always know it. When we have several days' work at the laboratory bench and are trying at the same time to put in a little operating at the chair every spare moment, is a time when this subject is often perplexing to us. The hands become so worn and stained that no ordinary washing will make them presentable. Some learn to do a part of their laborotary work in gloves. The writer has never learned to do any of the work in gloves. To have the office-boy keep everything used in the laboratory as free from rust and oxidations of every kind as possible will help a great deal in the care of the hands. When a rubber plate is taken from the flask, with the plate brush or the brush wheel carefully remove all plaster that it may not put in its work upon the hands. After polishing, wet the hands thoroughly and dry them, then apply a few drops of alcohol over the surface of the hands, followed by a good hand soap with water, sparingly at first, and our hands will come out much better than if no regard is paid to any of these rules. DENTAL SOCIETY 89

It is now admitted by all that the operating room should always be provided with water at some point in full view of the chair where the patient may see and know just what we do for our hands before coming to their mouths, and at most all times when we are operating it is highly important that we have hot as well as cold water at hand. No amount of washing with cold water will remove disagreable odors from the hands such as we come in contact with in scaling teeth, in extracting teeth, in treating pyorrhea, in treating root canals, and in the use of many of the mediciments we use in our work. We know these odors will often cling to our hands far beyond our ability to ascertain when we are rid of them, but the sensitive patient who has just come in from the odorless atmosphere whose olfactory nerves are alive to every surrounding, will easily detect them. To them it may be very annoying or disgusting if we fail to put forth special efforts along this line. When we operate for tubercular, syphilitic and many other classes of patients and hurriedly or unguardedly fail to recognize the great importance of the free use of hot water and suitable sterilizing agents we make dangerous vehicles of our hands for conveying such diseases to others. For removing many of the odors again a few drops of alcohol applied to the dry hands will greatly facilitate the cleansing. Alcohol will also remove iodine stains from the hands or an accidental spot on the patient's face or any linen fabric. If the adage, " We are our brother's keeper," has any meaning it is applicable to us when the welfare of our patient is taken into consideration. It is safe to say of the people who come for professional service at our hands, people of average intelligence, that they know more of law, more of medicine, or more of almost any subject we could mention than they do of what is proper and best for them in dental operations. Perhaps just here we may not go amiss to weigh a few points in regard to the wholesale destruction of human teeth with the extracting forceps. We often observe unsightly gaps in the healthy dental arch, caused by the sacrifice of important bicuspids or principal molars and wonder who could have been more to blame for such sacrifice - the patient or the operator. It is safe to say that any dental surgeon who thinks he has become an expert extractor may soon become a danger in any community. It is also safe to say that if the people knew the value of their own teeth as we know it, there would be fewer teeth extracted. They are not familiar with the many evil results attending the early extraction of the first permanent molars. They do not stop to think that in most cases the loss of one tooth practically puts two others out of use in the opposing jaw. Hence we must become judge and jury in the operations presented. Are we always able to give ourselves as good reasons for not treating teeth as we give our patients ? It is a fact that occasionally, after our best efforts have been put forth we must then apply the forceps, but while we are learning to lose a few we may learn to save many. 90 PROCEEDINGS OF NORTH CAROLINA

With our present knowledge of therapeutics, and the results of aseptic surgery, we may quickly bring offending and most worthless teeth and roots back to a healthy and useful state, with the successful methods of immediate root canal fillings it is a difficult matter to say when we are justifiable in the application of the extracting forceps. We must all agree that in some cases none of these rules will apply, but be sure we always let our conscience take a part in the matter, for we know better than do our patients what our operations cost them. Also it may be very unfortunate for any community to have for its dental advisor an enthusiastic lover of plate work. In some parts of the country it often becomes quite fashionable, for young girls to wear plates and many are pleased with them for the reason they do not ache and they induce others to hasten to the plate shop with an order for the same kind of work. " We often hear dentists says : I advise my patients as I think best for them, then I give them whatever they call for." Often there is nothing left for us to do except to see the inavoid- able necessity of plate work, but let us be content to find the existence of such conditions and see to it that our hands are never instru- mental in making such conditions. Again it would be safe to say if more dentists wore plates, fewer patients would be left with a never ending necessity of such fix- tures. Some of us may not be as unfortunate as we think we are if we are not provided with the various kinds of self-acting, rapid-firing-, seamless crown outfits. If a part of the price of such machines be invested in eyeglasses and mouth mirrors perhaps it will enable us to find stronger walls to retain another filling in many a frail looking bicuspid or molar. Do we at all times stand read}' to treat the ills of dental origin ? Do we occasionally turn on the search lights and with magnifying mirrors look ourselves over to ascertain if the degree of doctor of dental surgery we have had annexed to our names is not becoming obliterated by rust and rest. 5 We come from college with a score or more of complex prescrip- tions at our fingers ends, but how long before the right hand forgets her cunning. When our patients need systematic treatment we often try to excuse ourselves by turning them over to the physician. Do we always take time to do every operation with the minimum amount of pain necessary for its proper performance ? As science and art progress, the spirit of the age demands that we lessen the horrors of the dental office. We know that the dread of dental operations, ignorance of the laws of dental hygiene, and dental prophylaxis are the three prime causes of the loss of human teeth. Then, do we take time to give each patient, especially each young patient, a few plain comprehensive instructions in such laws ? We cannot expect them to know much of such laws if we do not make a more vigorous effort to have them taught in our public schools. In the heat of the campaign we stand on the streets and howl about what will or what will not come to the country if our favorite candidate is or is not elected president of the United States, or the advisability of constructing ship canals across the continents, when DENTAL SOCIETY 91 perhaps the subject of legislation upon how to prevent having to deal with so many root canals would be much more along the line with our duty. As citizens we should not forget to take part in the affairs of our country, but if we will see to it that the first five minutes of each public school child's school day, from the age of six until he is twenty-one, is spent in properly cleansing his or her teeth under the inspection of the teacher, we will do more for the part of suffering humanity we are licensed to have charge of than all of our opinion? upon national or international questions will do for the country. The more diligence and courage we are able to exercise, the happier will our days be.

DISCUSSION.

Dr. J. H. Wheeler : We cannot lay too much stress upon this — we cannot be too careful, because the first impression is oftimes the last impression. If a patient walks into a neat, well-kept office and sees well-kept instruments, he thinks that is a good office. You and I have seen offices where the tenor of the whole thing has repelled us. I am glad that Dr. Brooks has laid so much stress on clean hands in dentistry, and he has comprehended the whole thing in his paper. When I think of some of the famous men of our profession, such as Dr. Smith, Dr. Ryan and Dr. Ames, who are doing so much work to save teeth, the majority of which seemingly are beyond redemption, I think it behooves us to do much more than we are doing. The question is one of individual responsibility — to ourselves first, and then to our patients.

Dr. Brooks : Our patients do not know dentistry. We are the only people who know what phrophylaxis can do for them and we ought to do all we can to teach others to put it in practice. Subject was passed. A resolution in regard to a permanent place for the meetings of the Examining Board was presented by Dr. Turner. After extended discussion, a motion to adjourn and to post- pone the further discussion of this subject until next morning prevailed.

Friday Morning Session.

Pursuant to adjournment the convention was called to order by the president at 9 o'clock Friday morning. Discussion was resumed on the resolution presented the :

92 PROCEEDINGS OF NORTH CAROLINA

day before by Dr. Turner, after which, on motion of Dr. Ever- itt, the resolution was laid on the table.

THE INTERNATIONAL CONGRESS AT ST. LOUIS.

Dr. Alexander presented the letters received from the secretary of the Internation Congress of Dentists, to be held at St. Louis during the World's Fair. He explained the conditions on which membership in the proposed congress may be obtained, and many members of the convention availed themselves of the privilege offered. In addition to this a handsome cash contribution to the proposed congress was placed in the hands of the secretary to be forwarded to the treasurer of the congress. Dr. I. N. Carr read a paper on Some Practical Points Learned by Nearly Thirty Years of Actual Practice, as follows

Mr. President, and Gentlemen of the North Carolina State Dental

Society :

You have asked me through a member of your executive com mittee to write a paper for this meeting, and to select my own sub ject. In doing so I have only had in view a desire to write something that might be of benefit to the Society, and the younger membees especially. I bring to you today, " Some Practical Points Learned by Nearly Thirty Years of Actual Practice." In the first place, let me say that a good preliminary education, a neat, well-equipped and well kept dental office, supported by a scrupulously neat person, and genteel manners, promptness in filling all engagements, conscientious motives ruling every action, and sincere desire to save teeth, rather than to make money, should be the foundation stone upon which to build your professional structure of dental practice. It is the only safe, honest and successful method. I have learned that it is impossible to make a good approximal filling with any material until a good separation is secured. To accomplish this 1 know of nothing better than cotton pressed between the teeth, and where it is difficult to make it stay, it can be tied in place by first passing a piece of waxed silk floss up to the gingival border, then packing the cotton, and tieing securely. When yon desire immediate separation, I use the Perry separaters. Judiciousl} and carefully handled, sufficient space can be secured in from ten to twenty minutes without pain to the patient or injury to the teeth and where a matrix is desirable, use cushioning. For children under fifteen years of age, I separate the front teeth with rubber, a piecr not too thick is stretched between the teeth and cut off, and the child instructed to return as soon as the teeth begin to get sore enough to cause too much discomfort ; the rubber is then removed, and temporary stopping put in its place and left there until all soreness has disappeared. I have learned that it is best for both patient DENTAL SOCIETY 93

and dentist, never to attempt the filling of teeth until all soreness has disappeared — nothing handicaps the dentist so much, nor hurt* the patient more than pressing, or malleting a sore tooth. I have learned that capping exposed pulp is a waste of time, and invariably results in the death of the pulp, no matter by whom the operation was performed, or the material or medicament used. When a tooth has once ached from even a slightly exposed pulp, the only scientific practice is to remove the pulp and filliments — and fill the roots hermetically from apex to chamber. When this is properly done, the tooth should never again give trouble. It pays to be thorough in every kind of operation, but nowhere is the dividend so large as when the roots of teeth are properly treated and filled. I have found that gutta percha slightly moistened with eucalyptus oil makes the best and most satisfactory root filling, it can be carried wherever oxyphosphate can be used, and should trouble ever arise, it can be removed, whereas with any cement filling it is next to impossible to remove it. I say this in spite of all the advocates of cement root fillings. It is difficult to carry cement to the end of any root, without carrying air ahead of it, while a tiny point of gutta percha upon the end of a smooth brooch can be carried to the end little with or no air ahead of it ; this is then followed by a gutta percha cone. I know that if the apical foramen is sealed in this way, the important part of the work has been accomplished, and it matters

little what the balance of the root is filled with. Briefly stated : First, secure asepis, then seal the apical foramen hermetically with a tiny bit of gutta percha and you need fear no future trouble with that tooth root or roots. I have learned that it is best never to run a broach into a root until the dam has been applied and that in removng the pulp canal contents the broach should not be allowed to pass through the foramen as is too often the case, for in such an event the last state of that tooth is worse than the first. I have learned that there is as much in the dexterity and skill with which a broach is handled in such a root canal, as there is in any other operative procedure about the mouth and teeth. I have learned that it is best not to attempt to ream out root canals, unless a fine jeweler's Swiss broach, either four or eight sided, is used, and that even this should be used with extreme care. I never attempt to prepare a root for a porcelain crown until the dam has been adjusted, the tooth thoroughly treated, and cured of any trouble, and the apical foramen thoroughly filled. The root is then reamed with a suitable reamer for the reception of the post, and the margins trimmed down for a close joint with the crown — never place a porcelain or other crown, until a saturated solution of nitrate of silver has been used to prevent future decay. A gold crown should never be placed on a front tooth, and rarely upon any tooth with a living pulp except in the cases where a sound tooth is to be used for an abutment for a bridge. Almost every tooth that could be crowned successfully without destroying the pulp, can be saved by filling. Tin foil and gutta percha are the best materials with which to preserve young children's teeth. In this connection let me say that you should never deceive a child, for once deceived, confidence in you is forever gone. It is always best to be honest with your little patient, and when it becomes necessary to inflict pain tell them so frankly, but in a way not to frighten, but rather to gain more of 94 PROCEEDINGS OF NORTH CAROLINA

their confidence and trust. There is a knack in handling children which comes only to those who have cultivated great patience, and have studied and learned the nature of children. You can do almost anything with a child when you know how to handle him or her. The law of suggestion applies here as strongly as anywhere. Every man should study this law, and the fundamental principles underlying it, and it too, will pay a handsome dividend. I have learned that only keen-edged instruments should be used in excavating ; they give less pain and do the work much faster and more satisfactorily. When a bur becomes the least bit dull, it should be laid aside until a sufficient number have accumulated, when they should be sent to a reliable house where they are re-cut, and stoned, and not simply placed in a solution of sulphuric acid for a few hours, as some of the bur sharpeners do. I have learned that the best, surest and most scientific way to treat an abscess, whether it has a fistubulous opening or not, is, first, to wash out the cavity thoroughly with warm carbolized water, then adjust the dam, and clean out the cavity with a bur, then wash it out with hydrogen dioxide ; open into the chamber, and gain free access to the roots (no matter how much cutting you have to do, because unless you have this free access, you cannot successfully treat them) then with a Donaldson broach proceed to thoroughly cleanse the roots of all their contents, being careful not to allow the broach to pass through the apical foramen (this is especially to be avoided in abscesses without a fistulous opening). Now with a good bulb syringe, used only for this purpose, inject peroxide of hydrogen (not too forcibly, remembering that you are only cleansing the roots, and not the apical space) and allow the syringe to draw the fluid back, emptying into your cus- pidor, and again repeating the process until you are sure that the roots are clean. Now comes the treatment of the abscess proper. First dry the roots with little wisps of cotton on a smooth Donald- son broach, then inject with a minim syringe, a drop of pure sulphuric acid into each root, and pass a very fine platinum of gold broach up the canals, until you are satisfied that your acid has reached the abscess sack, then with a similar syringe, inject a solution of bi-carbonate of soda and draw that out with your syringe used for that purpose. Repeat this until you are confident of having neutralized the acid, and destroyed all germ life. Now dry the cavity and canals, and any cotton (saturated with oil of cassia and iodoform or eucalyptus and iodoform) into each canal, and wipe it about the walls of the canals so as to leave some of the medicament there ; then with a hot air syringe (continuous blast) blow the hot air into the roots, not too forcibly, but just enough to vaporize the oil and iodoform. Your tooth and roots are now thoroughly sterile, and you can proceed to fill them temporarily with cotton and the same medicament, and seal the cavity hermetically with temporary stopping. Dismiss your patient for two or three days as may be convenient, at the end of which time, if all soreness has disappeared, the dam should be again adjusted, the temporary filling removed, and the roots thoroughly filled with gutta-percha as described in the preceding pages of this paper. Your cavity can then be filled with whatever material you may deem best. A long procedure you may say, perhaps. Well, yes, it does take time and a lot of patience, but it pays, and pays well. It takes practice and DENTAL SOCIETY 95

experience too, to do this kind of work well, but anyone who is in earnest can acquire the necessary manipulative skill by patience and perseverance. Never allow a tooth to get the better of you until you have exhausted every means within your power, all the patience and skill at your command, to accomplish your object. I have learned that unless the walls are very thin, front teeth should not be cut away from the labial surface, but always from the palatine surface in order that as little gold may show as possible. The beauty of all artificial work lies in the concealment of the art.. I have also learned that it is not at all necessary to strike up gold cusps in making a bridge, but that a far better and more satisfactory way is as follows : After making and adjusting the abutments, I fill the intervening space with wax and carve the cusps to occlude with the antagonizing teeth, the wax is thoroughly chilled and a strip of No. 30 platinum foil is placed from abutment to abutment over the cusps and burnished carefully into the depressions, letting it lap over the buccal and lingual surfaces sufficiently to make a sort of box, after which the work is invested, the wax melted out, and solder flowed in to take the place of wax. It is necessary, however, to use a certain degree of care in soldering when the foil is used. A pointed flame should of course never be directed against the foil, as it would curl up, but by using a small investment, as in soldering single crowns, and heating the whole case to the fusing point of the solder used no changes will take place in the invested case and the solder will flow more easily and evenly. This method of soldering should prevail in every case, no matter whether the foil is used or not. I have learned that all surfaces to be soldered should be bright and clean, that it is poor economy of time to heat up a case too quickly, or to hasten its cooling. Many porcelain teeth and facings are cracked in this way. There is no excuse for chicking enamel under heat if proper care is exercised as above suggested. I saw a man once boil out a beautifully constructed gold bridge with porcelain facings, in acid, and immediately pour the acid off and then turn a stream of cold water into the pan containing the bridge ; result, three cracked facings, and a sorry, but wiser man. I have learned that no tooth or root should be crowned until it has been therapeutically prepared for the purpose. To crown an abscessed tooth with a fistulous opening without first curing the abscess, and filling the roots thoroughly, is nothing short of crim- inal. It is often practised by unscrupulous men who content themselves with the belief that because there is a fistulous opening, the patient will never know the difference. I have learned that plaster of Paris is the only proper thing to use when taking an impression with the crowns on the abutments, because itassures me that if I have properly ground the crowned teeth, they will come off in the plaster and if they will come off, they will certainly go back to place after the space lias been bridged and soldered, whereas a slight varation in the position of the two abutments — if they do not stand parallel to each other — the impression in wax or modeling compound will come off leaving the crowns behind, and although they can be placed in the impression apparently all right, yet when the

bridge is finished it will not go to place ; this is presuming of course, that the crowns fit the abutments snugly. Of course if they are 96 PROCEEDINGS OF NORTH CAROLINA made large enough, they could be inseted even if one abutment stood at an angle of 45 degrees; and the other stood perpendicular, but a bridge so constructed would of course be unfit to wear in any mouth. I have learned that wiping the inside of a gold crown with a little sweet oil during the process of fitting it to the tooth in the mouh, is a great help both to the patient and operator. That the old " adage, A little patience and sweet oil will accomplish wonders," applies here as in other cases. I have learned that during the process of preparing a tooth with a live pulp for a bridge abutment, and after its preparation, a saturated solution of nitrate of silver is a fine thing to use. It inhibits pains to a considerable extent during the process of grinding and prevents the pain caused by the freshly mixed cement when the crown is placed. No crown should be cemented on a tooth with a living pulp without first using the nitrate of silver, or coating the ground surface with some good etherial varnish. The man who does not believe this should have a crown placed on suck a tooth in his own mouth. I think he would then be very much like the man who had used the same piece of modelling compound over and over again in different mouths, until the time came to have an impression made of his own mouth ; when he, looking at the much used mass, concluded that he could not allow that to go into his mouth and so selected a fresh piece, and resloved that never thereafter would he use the same piece of milling compound or wax for more than one mouth. We should do by others as we would be done by. I have learned that a sharp groove made in the model all the way around the edge on the inside of the gum line, and across the back of the plate with a suitable instrument, will make a plate stick better than an air chamber and is far preferable. The raised ridge in the plate when vulcanized, will exclude the air, and thus make it hold on with wonderful tenacity. I have learned that the only absolutely correct way to get a perfect occlusion in

artificial dentures is as follows : After the teeth are set up in the articulator and appear to be all ight, the wax is then slightly warmed, and the plate placed in the patient's mouth, when he or she is asked to swallow and close the mouth, and then told to chew a little on her new teeth. The wax being soft, the base plate being made of Ideal base plate, and therefore rigid, in the process of chewing, you get an absolutely correct occlusion of all the teeth, so that when finished, there will be no grinding to do. I have learned that a lower plate, full or partial, must not extend down so far on the lingual side as to be lifted by the muscles and glands which often rise above the top of the ridge. Always have the patient raise the tongue to the roof of the mouth, and be governed accordingly. I have learned that to soap a modelling compound impression as you would a plaster one, will enable you to separate them more freely, and leaves the model perfectly clean. In waxing up a case for vul- it thus canizing, use a camel's hair brush and melted wax ; can be smoothly distributed, and the gum magins nicely festooned with little trouble. Instead of pouring boiling water into your flask to wa?h out wax from investment, have a 1-2 gal, pot elevated, with a faucet projecting from near the bottom, to which attach a piece of ordinary rubber hose with a small nozzle. The force of the flow of water is regulated by the height of the vessel and the wax is thus removed without disturbing the teeth, and much more neatly than the old DENTAL SOCIETY 97 way. To prevent teeth from dropping off the base plate while trying in the mouth, warm each tooth first, then melt a little wax on the backs of them by holding a stick of the material against the pins. Moisture will not then penetrate, and prevent teeth from adhering to the plate. I have learned that the quickest and best way to repair a vulcanite plate is to coat the cut edges with rubber cement, and replace removed portion of plate with fresh rubber slightly in excess of the quantity required when finished. Place a piece of tissue paper over the new rubber to keep plaster from adhering, and flask as in an ordinary case. When the flasks are separated, a depression will be found on plaster in the upper half into which the tissue paper will be found. Simply remove the paper, and fill the depression with fresh plaster, carefully outlining the surface. Now close the flask and vulcanize. By this procedure, no wax comes in contact with the freshly cut edges of the plates, and therefore a stronger union is secured. Society meeting I have learned that a long paper read before a becomes uninteresting, therefore, for fear that such may be the case with this one, I desist.

DISCUSSION.

Dr. Everitt: The paper just read is exceedingly interesting, but there was one point he did not elaborate on to my satis- he faction. I do not know whether he will agree with me, but speaks of dead teeth — teeth that have exposed nerves — how he gets into them and treats them. The treatment he gives is very nice, but I give a little incident in my experience in regard faces to dead nerves. I used to have a great many swelled from opening up dead teeth. I learned many years ago that tooth from my standpoint it would not do to open up a dead this morning and get ready at night to cleanse the root, espec- is going ially if there was a fistulous opening. A dead tooth to give you trouble. If you open it very freely and put in carbolic acid, or creosote, and leave it there 24 or 48 hours, and then put on a dam and cleanse the root thoroughly, it is possible that you will not have much trouble, but if you open that dead tooth and cleanse the parts at once you are going to havr trouble in 99 cases out of 100. not to crowd anything Dr. Spurgeon : You should be sure into it, but put it in very loosely. Dr. Jones: In regard to a blind abscess, if we don't deal with them carefully we will hear from them. I do not think that point can be emphasized too much — this delay^ the first oil is very time you touch it. My experience with eucalyptus satisfactory, but do not try to go down too deep the first time. I used to have a great deal of trouble, but less now. 98 PROCEEDINGS OF NORTH CAROLINA

Dr. Foster : I do not know when I have listened to a paper that I have enjoyed more and I hope to have a copy of it. One of the points which seems to me very important is these pulp chambers. You do not say how you open them. You speak about adjusting the dam, washing out the cavity, and then thoroughly enter the pulp chamber. The question is how to open into them. I have seen operators take a drill and go into the pulp chambers " ca-chuck," and hurt the patient so badly that he was sick next day. I never open into a dead tooth without using the smallest possible drill. In getting the nerves

out I have used two substances with satisfaction : One is forty per cent solution of formaldehyde — one of the finest substances for that purpose we have — carefully place a few drops of it in the canal. Another thing is formic acid. This may be used in disorganized organic structures, and it hard- ens those little nerve fibers that give us trouble. I mention these substances as practical therapeutics to overcome this difficulty.

Dr. Hauser : I enjoyed Dr. Carr's paper and I am particularly pleased that he goes into the minutiae of the operations. In regard to the use of formaldehyde, of which Dr. Foster has

just spoken, I use that almost daily and find it very efficacious. It is a powerful hardening material.

Dr. Alexander : This is one of the most instructive papers I have heard read, but I take issue with the author on one point. I understood you to say you put your antiseptic solution into the cavity with a syringe and then draw it back into the syringe — am I right ?

Dr. Carr : I say when the chamber is washed out then dry it and take a minum syringe and carry it down to the roots and draw out the substances that may be there.

Dr. Alexander : That is a very good treatment if you use a new syringe every time for each patient. I would not like it used on me after another patient.

Dr. Carr : There is nothing there for the syringe to take up except broken pieces of matter. If you have sulphuric acid it comes back into the syringe and no particle of it touches the other tissues. I have seen dentists use the same one over and over after washing it off. There is nothing improper about that.

Dr. Alexander : After you are through with the syringe if it can be kept in a thoroughly antiseptic condition I see no

objection ; otherwise it is a very serious matter. DENTAL SOCIETY 99

Dr. Watkins : I would like to hear more about the operation for immediate root fillings.

Dr. Alexander : I never practice that unless I am forced to.

Dr. Hilliard : Some force the medicine through the fistulous opening. I think some of the older members of this convention heard the statement of Dr. Hunter of a case which occurred a few years ago. The opening was on the outside of a first molar — it was decayed on the crown more than on the surface, and he could not use a pump but with a sharp point he put four or five drops of creosote well down, and when the wound healed over there was just a little scar.

Dr. Wyche : The paper is excellently written, and he goes into the minutiae of operations, but he speaks of adjusting a rubber dam in all cases for treatment of dead teeth. I used to do that but I quit it — it was too much in the way. I have good success without it — I can't get at the roots in that way. Then he speaks of pumping acid through the root.

Dr. Carr : I did not mention carbolic acid, and I do not use coagulants in the teeth — not even if there is a fistulous opening — except in tooth-ache.

Dr. Everitt : Dr. Jones spoke of filling teeth having fistulous openings — after one treatment he pumps his medicament through and says the result is satisfactory. There are so many ways of filling roots — it is very seldom that I use zinc for exposed nerves — I use cocaine exclusively now for the immediate extraction of a nerve. In regard to abscess of the teeth, I am guilty of a little irregularity, as I think we all are sometimes. I had a case this last February — the time I was sick — Dr. Fleming opened a tooth and the lateral root had a blind abscess, but he stated to me there was very little discharge. A day or two afterwards the gentleman came into my office and the part was full of pus. I dressed that tooth with everything I could suggest for fully a month, I think, and the flow of pus increased all the time. I do not exaggerate by saying that the last time I treated it two drams of pus came from it. Where it came from I could not discover. There was no indication of an exterior abscess on the gum or the roof of the mouth. The patient was healthy, an athlete, a second baseman in a baseball team, and never knew what it was to be sick. But the treatment was successful as far as I know. The treatment used, as Dr. Fleming suggested to me, was " pustuline." He sent it over and I tried it. He has had it so long it was actually dried 100 PROCEEDINGS OF NORTH CAROLINA up and hard. I made a paste of it and then with a cone of gutta-percha I put a little of the paste in and closed up the chamber carefully. I said now let us hear from you if you have any trouble. Two days afterwards I saw him and he seemed to be doing well. The next afternon he came in and there was a fistulous opening, and there was that preparation I had used which looked like a white thread hanging out of that opening fully one-fourth of an inch. It looked like a cambric thread just the size of the opening. It worked out for three or four days and then healed up. Afterwards I put in a gold filling. From the time I used that pustuline he never had a moment of discomfort. I did it as an experiment — it was an extreme case — I expected to have to take the tooth out. I give this account for what it is worth.

Dr. Horton : I had another case like that — the tooth would not submit to treatment and I used pustuline in it. The pus was abundant. I have used dry thyme and thymol mixed with arsenic, and iodoform. Some weeks ago I was going to put on a bridge for a lady. I opened up the tooth — a second bicuspid — and it showed a fistulous opening. As soon as I was through the crown I found pus — there was no question about that. I punctured it and she was comfortable. I was afraid I might set up irrita- tion, but concluded to take my chances. I washed out the canal and placed pustuline in it. I do not know whether it did or did not come out at the fistulous opening, but there is now no sign of any trouble and the tooth is in perfect health.

Dr. Harris : As to immediate root fillings, it is my practice to fill immediately where I take out a nerve. I believe it is right. I would like to ask Dr. Alexander if he finds a certain amount of soreness when filling roots?

Dr. Alexander : I have in some cases but it went right away in a short time. Dr. A. H. Fleming: I had a similar case, a lateral incisor. Dr. Arrington was in my office, and the patient had come to me several times — there was no cavity and no discoloration — I did not feel like opening into it, but about a month ago this gentleman returned and I thought then I would do it. I found the nerve putrescent, I suppose a teaspoonful of pus came from it. I treated it every time with creosote, and the pus kept increasing although there was no opening, so I thought I would look that thing up. I did so and used pustuline and the tooth got well. Dr. Carr: I want to express my appreciation for the kind DENTAL SOCIETY 101

manner in which my paper was received ; also would say that the paper was not on the subject of treating abscessed teeth although I alluded to that. I hope some one will write a paper sometime on that subject. I was particular in describing my method of treatment, and in going into the pulp chambers I always adjust the rubber dam. I do not bore into it and flush it with the solution as you might flush a sewer with water from a hose — I do not do it that way. First clean out the cavity, then take a small drill and take time enough to find the chamber. Then take a larger drill and enlarge the opening until you get at the outlets of the chamber. Dr. Hilliard wants to know how to get the nerve filaments out of the canal. I do not claim to fill every canal without difficulty but in the majority of cases you can get to the apex of every one of them. In some cases you can only put in antiseptics, and in a majority of cases you can get the teeth in a healthy condition. The point Dr. Foster makes is well taken — I never use the large drill at the start. I never go into the chamber with anything until the rubber dam is adjusted. My object is to not force anything through the foramen, but bore into it until I feel I have gotten down to the foramen, then take sulphuric acid and inject it, then fill it with bicarbonate of soda and draw it out. A small bulb will not do because you want force enough to draw it out. You will be astonished to know how much pus you can draw out in that way. But do not force it too hard — do not shove through the root until you get through with this process. If you get rid of all the causes of this trouble you will have good teeth afterwards. It should be done right away before the tooth is too sore. If it is pain- ful I would open it and do as Dr. Everitt suggests. If there is anything I have tried to do, it is to saved diseased teeth. Use force enough to inject the fluid clear through, and no matter whether it is white, red or brown it has done its work. In blind abscesses I do the same thing, I use sulphuric acid full strength ; I do not use coagulants in root canals. Sulphuric acid destroys tissue ; I mean I do not use anything that is going to coagulate the different fluids that may be in the tubuli. Such a fluid would leave these mouths with whatever there may be in them sealed up, but in this pumping process the contents of the pump do not close up these tubuli. Dr. Jones: I do not think it is safe to use sulphuric acid — to force it into the root of a tooth.

Dr. Carr : I believe what I have said about its use is true. I do not believe there can be any trouble coming from the use 102 PROCEEDINGS OF NORTH CAROLINA of sulphuric acid as I have described it for the reason that you have neutralized every speck of it. For twenty years I used peroxide of sodium a good deal, but some of the atoms of the oxide would remain there and cause trouble, so I abandoned that altogether. As to materials for root filling Dr. Everitt has endorsed me in the use of gutta-percha. Some canals are very small and not always straight. Cut off a little of one of these gutta- percha cones and take a little oil of eucalyptus or of cassia and with a gentle push the air will go right out instead of going ahead. If you do not make a plunge — if you know from a sense of touch what you are doing — you have got that opening where you want it. I have not taken out the root fillings of two out of one hundred that I have filled in twenty years. Dr. Everitt: We are all inclined to relate our success—very few of us tell about our failures. I have had a lot of failures, and they tell on us. Many of us treat teeth, fill roots, make but one operation and think we have great success, but we never hear of our failures. You may meet the patient after the operation and hear them express their appreciation and gratifica- tion, and you will think it was a grand success, but that tooth has been given a sun bath long ago. I remember about a year ago a member of our Society was in Raleigh — one of our best operators was right there, and he made a pretty little talk about an operation he had performed, gave a history of all the bicuspids he had treated about a year before, and what a grand success — they had never given any trouble. I told him if he would walk down to my office I would show him that tooth that had never given any trouble. It had had a sun bath. We are apt to tell about our grand successes that are not successes. We may treat a man today and not see him afterwards — he may go off, and that tooth begins to give him trouble, and if you were near enough you would hear from him a few adjectives, and he says he was robbed, and now that tooth has had a sun bath. Subject was passed.

Dr. Jamieson being absent, the secretary, Dr. J. S. Betts, read the paper on Some of the Uses of Gutta-Percha, as follows:

SOME OF THE USES OF GUTTA-PERCHA.

Mr. President, and Gentlemen of the North Carolina Dental Society : That man is comparatively young who does not harbor somewhere DENTAL SOCIETY 103 in his mind, a pathetic desire to make a speech or read a paper bear- ing on some certain line of his work, and all of this is very good if in the end he has benefited mankind, and filled in that portion of the circle which is his part in the great plan. " " Too often it seems to me, we consider it almost a sin to repeat some of the old things, when perhaps by doing so we might add at least a small portion to the sum total of goodness in the world. For " this reason I am calling your attention to Some of the uses of Gutta-Percha." Gutta-percha is the resinous exudate of the Isonandra Gutta, found extensively in Borneo, Sumatra and Malayan Peninsula. It was first brought to the notice of the dental profession in 1842, by Dr. Mont- gomery, of Bengal, and before many years attracted much attention because of the valuable properties which make it indispensable to the dentist. Corallite, a preparation of gutta-percha combined with one-half its weight of sulphur and the compound then mixed with one-half its weight of vermilion formed a compound which hardened under the same conditions as vulcanite, and of which it promised to become a formidable rival, but unfortunately, one property of the crude gutta-percha followed it into the combination — the tendency to become brittle, pure crude gum, or that prepared for dental use by the large admixture of foreign matter, will in time become so brittle as to break almost at the touch. The vulcanized gutta-percha has the same property in a less marked degree. The presence of gutta-percha in sulphurated caontchonc preparations should always condemn them for dental use. The use of vulcanized gutta-percha rubber, now so prevalent all over the country, it seems to me is not the proper thing to do. We do not notice any deterioration around the gingival margins of our denture, but if you will examine slightly posterior to the front teeth you will notice a stippled condition, which means that the gutta-percha has gotten in its work, and very soon some of the teeth will shake loose, much to the discomfort of the patient and chagrin of the dentist. My experience with vulcanized gutta-percha rubber has been a failure, certainly so as regards the construction of full dentures. They look pretty at first but do not stand the wear and tear of everyday mastication, but for quick mends, where your patient comes from a distance, and does not relish the idea of going about with sunken jaw, and the consequent embarrassment therefrom, I have found gutta-percha rubber to be of great value as a time saver and con- server of peace with your patient. Gutta-percha is of great value in the treatment and preservation of the teeth of children, especially those children whose parents pay very little attention to the teeth until the little ones cry out with pain. Usually, in such cases, we must resort to the use of gutta- percha because of the ease of manipulation and also its non-conduct- in ing properties. It is also widely used as a permanent filling pulpless decidous teeth, especially where the teeth have died from neg- of using lect, and there may be some doubt as to the advisability either oxyposphate or any of the metallic fillings. It is of use as a retainer of both barrel and pin crowns, where perhaps we have been recently treating a foul root or may be having some trouble with a for devitalized pulp Last winter I kept a Richmond crown in place nine weeks, in a case where some doubt was felt as to the condition 104 PROCEEDINGS OF NORTH CAROLINA c,[ the peridental membrane near the apical space. This is done by slightly roughing the pin with a knife blade or fine file, then place a thin disk of gutta-percha over the cap of the Richmond so as to cover the edges of the band, a thin ribbon of the same material is then wrapped around the pin, coming entirely down to the cap portion ; I then grease the canal thoroughly to keep the gutta-percha from sticking at the first fitting, the crown and gutta-percha are warmed and then pressed into place ; this fitting being done to prevent too great a surplus in the final setting. The crown is then removed and all grease removed from the canal, crown and pin ; another ribbon is then added to the pin, the whole is heated and pressed into place. In case the crown does not go entirely up, a metal instrument of considerable size, or one made for the purpose is heated and held at a point opposite the pin in the posterior part of the crown. Usually with a little pressure no trouble is experienced in pressing the crown in place. Almost any crown may be set in about the same manner. Some- times before trimming" the enamel from a root being prepared for a Richmond crown, gutta-percha appears in a very valuable way. A cap is made of gutta-percha to cover the end of the root and to extend slightly beneath the gingival margin, an old Logan crown may then be pressed into place to fill the space of the lost tooth, and all left for the space of three or four days ; it is surprising how much better we can work when we have plenty of room, and on the removal of the gutta-percrha cap the gum will stand slightly away from the root, and the operation will appeal to the patient as not half so bad as some friend may have told him. Here is a case showing the length of time gutta-percha lasts when only protected to some degree : Mrs. A. came for the resetting of a superior lateral shell crown ; upon examination I found the dentist had built up with gutta-percha a lateral tooth which had been broken off far beneath the gum on the labial surface, and only showing one- eighth inch of tooth surface posteriorly, and after getting the required shape had set the crown with some of the oxyphosphate preparations. The cement gave forth a very foul odor, whereas, from the gutta-percha there was none. The crown had been used seven and one-half years. If the gutta-percha cement, now being tried, proves to be a complete success, for which we all hope, the disagreeable odor arising from the use of cement in the placing of crowns and bridges, will be at an end. The best bridge ever constructed will become offensive in some degree if our setting material is of a porous character, now, if gutta-percha cement can be used, the problem is solved, for should the work become offensive, remove it by the use of a little heat, disinfect and reset as at first. Gutta-percha is sometimes used to enlarge the capacity of an impression tray, in which case it should first be made into a ball and then worked out to fit the tray, being thicker in the center and thin at the sides. It may also be used as a rim at the posterior margin of the tray, but wax has served the purpose better for me. Perhaps the most important use of gutta-percha is as a filling for use care where root canals and pulp chambers ; however, we should a large metal filling is to be placed over a pulp chamber filled with gutta-percha, because of the pliability of the gutta-percha which might cause a sinking, as it were, of the metal. DENTAL SOCIETY 105

I have had fine success in the use of gutta-percha over pulps which are protected by only a thin layer of dentine, most commonly using the preparation, chloro-percha, as it may be used without the use of pressure, but I do not believe in leaving decay at the bottom of a cavity in order to preserve the integrity of the pulp, for if decay is left, there will be moisture and a consequent production of foul gases uniting in further trouble to the patient. The way I use gutta-percha in dead teeth is to fill the canals and chambers thoroughly with gutta-percha, then a layer of cement, and on top of that the metal filling, this is a saving to the dentist and a favor to the patient. In the filling of root canals, I first varnish the whole length of the canal with chloro-percha and then apply the points with a firm and gentle pressure. If a canal is properly filled with percha preparations there can never be any odor, but if cement is used there is certainty of the absorption of fluids which in time set free the foulest of gases. In a case where there is a large opening at the apex from continued abscess, and some danger of pushing gutta-percha through into the apical space, I fill the foraminal openings with a piece of pure lead wire trimmed to fit the opening at is introduced into the canal and a the apex of tooth ; the wire then measure taken, making a notch to show just the distance to the point to be filled, then with a small file go entirely around the wire so as to make a small plug, but do not sever it entirely from the body of the wire, now place some quick setting cement around the circumference of plug, push the plug into place at the foramen, wait a few minutes for cement to harden, then with a quick twist break the body of the wire from the plug, you may then proceed with the use of gutta- percha in lower part of canal. of the I will say here, that the use of chloroform in the sealing coronal ends of canals is always indicated, and it is best to use it every time a piece of gutta-percha is called into service. It is not recommended to use gutta-percha as a sealing over treatment where to the arsenic is used for the reason there may be some pressure dying pulp, or an escape of arsenic so as to come in contact with the tissues of the mouth. It is best to seal all arsenical treatments with cement, as the patient is safe and the dentist relieved of mental worry brought about by fear of arsenical poisoning. care I have no patience with a man who does not use the same in the working or gutta-percha as he does in the setting of the most delicate porcelain filling. He may last, "but can not live." I leave the subject with you.

DISCUSSION.

in using gutta-percha, but Dr. Wyche : I used chloroform I have had trouble with that and have discarded it. deal I have saved Dr. White : I use gutta-percha a good — temporary teeth where I could not have saved them with anything else. Dr. Harris: My chief use for gutta-percha has been in children's teeth. Dr. Jones: My chief experience with gutta-percha is in 106 PROCEEDINGS OF NORTH CAROLINA

the teeth of children from sixteen to eighteen years old, and sometimes later than that, and I have found it twice as useful as any cement I have ever tried to use. The average life of a gold filling is less than many of us suppose. I have some gutta-percha fillings that have been in eight years, and perhaps ten. I believe many of us miss it very much by trying to fill the teeth of young persons before the age of eighteen or twenty. I use a preparation of White's, called premium gutta-percha. It should be heated over lamps specially for that purpose. Do not try to fill two or three teeth with the same material, but use every time a new piece of gutta- percha. I have seen some who are careless — I do not think they represent our profession — cut off a piece and try to use it by holding it over the flame of a lamp. It cannot be used successfully that way.

Dr. Foster : I take issue with one point in the paper. He says gutta-percha has more resistance in absorbing hot gas than cement, and that it is less offensive. I do not think this is correct, some cements will absorb gas more readily than gutta-percha. I do not advocate any particular cement, but I use Ames' metalloid. I have made some mistakes by soften- ing gutta-percha.

Dr. Carr : Dr. Foster makes the statement that gutta- percha absorbs more gas than cement. I think he is wrong. Gutta-percha does not absorb anything — it is impossible that it should — it is a perfect non-conductor — it will net absorb alcohol. The odor you find is not from the absoq tion of gas^s but because the cavity has not been wiped out before gutta- percha is put in — it is not from the gutta-percha.

Dr. Livermon : Having prepared the cavity and wiped it out with oil, do you leave any of the oil in there? Dr. Carr: I prepare the cavity thoroughly — I do net say I flood the cavity — I wipe it with oil and th^n dry it out, then use the gutta-percha. Subject was passed.

FRIDAY.— Afternoon Session.

The afternoon session was devoted to clinics, and the report of the supervisor of clinics was read by Dr. H. D. Harper, Sr., as follows: DENTAL SOCIETY 107

REPORT OF CLINIC.

Dr. I. N. Carr, of Durham, demonstrated his method of cavity- preparation. Dr. A. H. Fleming, of Louisburg, made a gold shell crown with carved cusps showing the advantages of carving cusps over swaging cusps for more perfect articulations. inserted in mesio-approximal Dr. J. N. Johnson, of Goldsboro, porcelain inlay in lateral incisor. inserted gold filling in dental Dr. J. R. Edmondson, of Wilson, surface of right central incisor. Dr. Geo. B. Patterson, of Fayetteville, demonstrated his method of taking plaster impressions and wax bite for full upper and lower sets of teeth. Dr. Sid P. Hilliard, of Rocky Mount, filled approximal aspect and cutting edge of central incisor with No. 4 cohesive gold foil. The gold held in position by irregular shape of cavity, rather than by undercuts or retaining points. Dr. Wm. Crenshaw, of Atlanta, in table clinic, demonstrated his method of filling incisors with soft gold with front tooth matrix. exhibited the results of mixture Dr. J. A. Gorman, of Asheville, of porcelain with cement powder to be baked first in inlay to aid the attachment of cement to the inlay. Also exhibited models and pictures of a number of cases in orthodontia. Dr. Chas. L. Alexander, of Charlotte, demonstrated the use of a new instrument of his invention, for cleansing teeth. The new tool consisted of a hand-piece, which, when adjusted to the dental engine, produced a reciprocating movement instead of revolving. Cone socket points of various shapes and a point for holding a wedge of orange wood were used in the execution of the work.

Memorial £>txWt

At five o'clock a memorial service was held in memory of a paper on The Life and Character Dr. J. A. Ballentine, when read Dr. R. E. Ware, as fol- of Dr. J. A. Ballentine was by

lows :

LIFE AND CHARACTER OF DR. J. A. BALLENTINE.

Just two months after the adjournment of our last annual meeting, the death angel entered our ranks and called from time to eternity the spirit of our honored brother, Dr. J. A. Ballentine. Dr. Ballentine was born in Harnett County, N. C, February 23rd, 1858. He was the son of David G. and Nancy J. Ballentine. He was a dutiful and obedient son and a kind and loving brother. He entered the Baltimore College of Dental Surgery in the fall of 1880, and graduated March 7th, 1882. He practiced dentistry the two following years with Dr. Small in Fayetteville, N. C. In 1884, 108 PROCEEDINGS OF NORTH CAROLINA

Dr. Ballentine located in Jonesboro, N. C, where he remained until his death, August 21st, 1903. By faithful, conscientious, and substantial work, he soon gained an enviable reputation and established a lucrative practice. Dr. Ballentine joined the North Carolina Dental Society in Raleigh, in 1S88, and was an honored member. Those who knew him best loved him most. Early in life he gave his heart to God and joined the Baptist church and became, as he grew to manhood, a very zealous and earnest church worker. He loved the Sunday-School work especially, and when he died, he had not only been moderator of the Sandy Creek Baptist Association two yars, but also superintendent of the Jonesboro Baptist Sunday-School for nine years. A faithful conscientious Christian can not help bieng a conscientious dentist. An honest conscientious dentist should be a faithful Christian. Let us consider both the latter as well as the former. On the 4th day of May, 1884, Dr. Ballentine was married to Miss Minnie Bell, a cultured and Christian lady of Chatham County. His wife, two sisters, and father survive him. Genial, hospitable, big- hearted, and entertaining, he will be greatly missed not only by them but by all who knew him. Let us cherish his memory and try to emulate his example both as a dentist and as a Christian.

Opportunity having been given to others to speak many members of the Society took occasion to express their appreciation of the paper and of their respect for the memory of Dr. Ballentine. The remarks by Dr. Carr were as follows: I am glad for the privilege of saying a few words in memory of my friend, Dr. Ballentine, for I do now and shall always respect his memory. We were well acquainted, in fact were intimate with each other. We frequently came in contact and always to our mutual benefit. We often consulted each other, either by personal interview or by letter upon the materials and the methods of the practice of dentistry, and I always found his suggestions wise and safe to follow. As a general practitioner I think it may be safely said that he was one of the best we have ever had in this State. As a practitioner he was sincere, painstaking, enthusiastic and progressive. No shoddy work ever came from his hands. If he ever failed it was not because he did not make a conscientious and honest effort to succeed. He was as painstaking with a comparatively unremunerative case as he was with one that was more expensive. He was never satisfied with what was good enough if

something better was within his reach ; and he was never satisfied with what was better if the best was to be had.

He was an earnest supporter of this Society ; he was seldom absent from its meetings, and was always ready to take any part assigned to him. He was careful and painstaking in preparing his papers and his discussions, and we shall all miss :

DENTAL SOCIETY 109 him from our annual meetings. He was a conscientious, safe, fellow practi- good man ; he had the respect, not only of his tioners, but also of all the people in the community in which he lived. The memory of a good man shall not perish.

The following members of the Society were dropped from the roll on account of non-payment of dues : C. S. Boyett and H. G. Holland.

The treasurer's report was read and adopted, as follows TREASURER'S REPORT.

Amount on hand last report $110.48 Received for membership I35- 00 Received for dues 229.20 Received for reinstatement 12.00 Received for note 150.00

Total $636.68

DISBURSEMENTS.

Paid R. H. Jones, services on text-book $ 29.40 Stenographer at Winston 25.00 janitor, Winston 5 00 clmic material, Winston 19-53 membership fee returned 5 00 editing proceedings of society 25.00 publishing proceedings 130.00 note 150.00 interest on note 6.38 D. T. Southwick, services on text-books 1920 Sec. salary SO.00 Sec. expenses 37-95 Treas. salary 25.00 Treas. expenses -50

Total I527-996

Balance on hand $108.72 REPORT OF FINANCE COMMITTEE.

We, the Finance Committee, beg leave to submit the following

report : We have examined the Treasurer's accounts and find them neatly kept and accurately balanced. L. L. DAMERON, JR. ROBT. L. RAMSEY, W. M. ROBEY. :

110 PROCEEDINGS OF NORTH CAROLINA

The publishing committee's report was read and adopted as follows

To the Officers and Members of the North Carolina State Dental

Society :

The publishing committee, in making report, desires to state that the work of publishing the proceedings of 1903 was carried out as quickly as possible, consistent with the nature of the work. The committee also desires to thank the officers of the Society who so kindly assisted in making the list of membership correct. Respectfully submitted, F. L. HUNT.

Resolved, That a vote of thanks be tendered to the members of the examining board for their courtesy in giving to the Society a delightful sail on the Sound.

REMARKS BY THE RETIRING PRESIDENT.

I desire to return my hearty thanks to the members of this Society for their kindness in electing me President of the Soci- ety during the past year, and for the cordiality and earnestness with which they have carried out the program. I appreciate it greatly and shall remember it with much pleasure. On motion the treasurer was authorized to pay the janitor $5 for his services during the convention.

ELECTION OF OFFICERS.

The following are the officers elected for next year: President — Dr. W. B. Ramsay. First Vice-President — Dr. J. D. Whitaker. Second Vice-President — Dr. W. M. Robey. Secretary — Dr. J. S. Betts. Treasurer — Dr. R. M. Morrow.

Essayist — Dr. J. R. Edmundson.

INSTALLATION OF OFFICERS-ELECT.

Dr. Everitt and Dr. Tucker conducted the new officers to their chairs on the rostrum, and each. in a very appropriate speech expressed his appreciation of the honor bestowed. :

DENTAL SOCIETY 111

The report of committee on ethics was read and adopted as follows

To the President and Members of the North Carolina Dental Society : Your committee on dental ethics would call to your attention an advertisement by Dr. Frank Boyette, which is a violation of our Code of Ethics and recommend that he be made to answer for the same and also for charges of violating a contract, and of conduct unbecom- ing a gentleman. V. E. TURNER, H. D.HARPER, R. H. JONES.

Members present at meeting at Morehead City, June 29-July 2,

1904 :

C. L. Alexander, R. T. Allen, J. H. Benton, J. S. Betts, C. A. Bland, J. H. Brooks, Isaac N. Carr, N. G. Carroll, E. O. Chambers, L. L. Dameron, I. H. Davis, W. Ross Davis, E. F. Early, J. R. Edmundson, D. E. Everitt, Thos. H. Faulkner, Arthur H. Fleming, D. J. Martin Fleming, A. E. Frazier, L. I. Gidney, J. A. Gorman, H. Harper, Sr., H. D. Harper, Jr., F. S. Harris, S. P. Hilliard, P. E. Hor- ton, F. L. Hunt, D. L. James, J. N. Johnson, R. H. Jones, J. H. Judd, A. C. Livermon, F. W. McCrackin, J. T. McCrackin, J. E. Matthews, R. M. Morrow, J. C. Osborne, J. Ruffin Osborne, G. B. Patterson, E. A. Perry, R. L. Ramsay, W. B. Ramsay, C. W. Regan, W. M. Robey, C. F. Smithson, J. S. Spurgeon, C. A. Thompson, E. J. Tucker, V. E. Turner, R. E. Ware, J. C. Watkins, J. H. Wheeler, Joel D. Whitaker, J. A. White, L. White, J. E. Wyche.

Honorary : Wm. Crenshaw, Atlanta, Ga.; M. E. Turner, Atlanta, Ga.; S. W. Foster, Atlanta, Ga.

List of delegates to the National and the Southern Branch of the

National Dental Associations :

J. R. Edmundson, H. C. Henderson, J. J. Battle, J. H. Judd, J. E. Banner, L. G. Reid, Arhtur H. Fleming, W. M. Robey, A. E. Frazier, R. L. Carr, J. T. McCrackin, J. G. Marler, R. M. Morrow, Joel D. Whitaker, D. L. James, I. W. Jamieson, B. F. Hall, H. D. Harper, Jr., F. W. McCrackin, L. A. Hauser. PLACE OF MEETING NEXT YEAR.

Waynesville and Durham were in a felicitous manner placed in nomination, each extending a hearty welcome to the Society. The ballots when counted showed that Waynesville had been selected.

On motion the Society adjourned sine die to meet at Waynesville, the time to be selected by the executive committee. PASSED STATE BOARD

C. P. Norris Cosma, N. C. R. H. McLaughlin Charlotte, N. C. J. T. Pittard Henderson, N. C. W. L. Ezzell Poortith, N. C. D. K. Lockhart Hillsboro, N. C. W. V. Pittman Ashpole, N. C. S. R. Horton Raleigh, N. C. R. J. Morrison Cherryville, N. C. W. E. Snipes Menola, N. C. F. W. Eubank Hendersonville, N. C. R. T. Nichols Rockingham, N. C. F. G. Chamblee Wakefield, N. C. B. R. Long Roxboro, N. C. R. W. Stephens Raleigh, N. C. M. M. Harris Raleigh, N. C. Oscar Hooks Richmond, Va. J. R. Highsmith Parkersburg, N. C. J. H. Ihrie Pittsboro, N. C. Chas. E. Smith Salisbury, N. C. H. R. Cromartie Clarkton, N. C. Chancy Highsmith Parkersburg, N. C. R. M. Squires Salemburg, N. C. J. E. Warren Mayodan, N. C. J. D. Carlton Warsaw, N. C. I. M. Mann Asheville, N. C. R. G. Sherrill Raleigh, N. C. N. A. Culbreth Wilmington, N. C. .

Fayetteville Goodwin, J. C Dunn Patterson, G. B High Point Griffith, J. F Salisbury Perkins, F. E Hall, B. F Asheville Perry, E. A Littleton Hall, C. B Prospect Hill Pittard, J. T Henderson

* Died since last meeting-. COMMITTEES

Executive. Ethics.

Dr. J. F. Griffith, Chairman, Dr. V. E. Turner, Chairman, Dr. E. J. Tucker, Dr. H. D. Harper, Sr., Dr. J. H. Wheeler. Dr. R. H. Jones.

Necrology. History.

Dr. R. E. Ware, Chairman. Dr. D. E. Everitt, Chairman, Dr. G. B. Patterson, Dr. V. E. Turner, Dr. J. C. Watkins. Dr. J. F. Griffith. ROLL OF MEMBERS

Alexander, C. L Charlotte Harper, H. D., Sr Kinston Allen, R. T Lumberton Harper, H. D., Jr Kinston Banner, J. E Mt. Airy Harris, F. S Henderson Banks, C. H Haw River Harris. M. M Raleigh S. Rocky Mount Battle, J. J Rocky Mount Hilliard. P Bender, O. J Pollocksville Henderson, H. C Charlotte * Herndon,W.T..Laurensburg,S.C. Benton, J. H New Bern Smithfield Betts, J. S Greensboro Holland, N. T Hooks, Oscar Fremont Biggs, J. D., Jr. . . .Williamston Bland, C. A Charlotte Horton, H. V Winston Bland, M. A Charlotte Horton, P. E Winston Booth. R. S Warrenton Hunt, F. L Asheville Boyette, Frank Goldsboro Hunter, E. L Fayetteville Ihrie, Pittsboro Boyette, M...... Wadesboro J. H J. Woodland Brooks, J. H Burlington Jacobs, J. M Carr, Geo. A Durham James, D. L Greenville Carr, Isaac N Durham Jamieson, I. W Charlotte Carr, R. L Greenville Jeter, I. P Morganton Carroll, N. G Raleigh Johnson, J. N Goldsboro Carlton, J. D Warsaw Tones, R. H Winston FI Fayetteville Carlton, J. W Spencer Judd, J. Chambers, E. O Asheville Keerans, E. P Charlotte Cole, R. S Rockingham Dee, S. P. J Smithfield Conrad, W. J Winston Lennon, C. H Whiteville Newton Croom, J. D., Jr Maxton Little, J. B Culbreth, N. M Wilmington Livermon, A. C. Scotland Neck Dameron, L. L New Bern Lynch, Wm Durham Daniel, H. C Troy Mann, I. M Asheville Davis, I. H Oxford Mann, L. H Middleton Davis, W. Ross Whiteville McCrackin, F. W Sanford Early, E. F New Bern McCrackin, J. T Durham Edwards, W. H...Wake Forest Mclver, D. C Laurinburg Yadkinville Edmundson, J. R Wilson Marler, J. G Everitt, D. E Raleigh Matthews, J. E Wilmington R. Cherryville Eubank, F. W. . Hendersonville Morrison, J Ezzell, W. Lee Poortith Morrow, R. M Burlington Faulkner, Thos. H Kinston Mott, C. B Statesyille Fleming, A. H Louisburg Nichols, R. T Rockingham Cosma Fleming, J. M Raleigh Norris, C. P Frazier, A. E High Point Osborne, J. C Lawndale Gallagher, R. T. .. .Washington Osborne. J. R Shelby Gidney, L. I Shelby Parker, H. R Trenton Goldsboro Gorman, J. A Asheville Parker, J. M Fayetteville Goodwin, J. C Dunn Patterson, G. B High Point Griffith, J. F Salisbury Perkins, F. E Hall, B. F Asheville Perry, E. A Littleton Hall, C. B Prospect Hill Pittard. J. T Henderson

* Died since last meeting. Pitts, H. C High Point Spurgeon, J. S Hillsboro Powell, C. G Potecasi Squires, R. M Salemburg Ramsay, R. L Salisbury Stanly, J. W Chadburn Ramsay, W. B Hickory Thompson, C A Wilson Regan, C. W Laurinburg Tucker, E. J Roxboro Regan, J. D Lumberton Turner, V. E Raleigh Reid, J. G Marion Vitou, E. C Southport Reid, L. G Lenoir Walters, H. N Warrenton Robey, W. M Red Springs Ware, R. E Shelby Rominger, C. A..Zion City, Ills. Warren, J. Ed Mayodan Ross. T. T Weldon Watkins, J. C Salem Rowe, W. W Reidsville Wheeler, J. H Greensboro Satterfield, H. G. . Prospect Hill Whisnant, J. F Henrietta Sherrill, R. G Raleigh Whitaker, J. D Raleigh Smathers, Wexler Asheville White, J. A Hobgood Smith, Chas. E Salisbury White, L Statesville Smithson, C. F... Rocky Mount Whitehead, C. A Tarboro Smithwick, D. T. . . .Louisburg Whitsett, G. W Greensboro Snell, H Washington Wyche, J. E Greensboro Snipes, W. E Menola